Alberto Matteeli of Italy began his presentation on HIV and tuberculosis (TB) by reminding his audience that in the pre-antiretroviral therapy (ART) era in Europe and the United States, there were serious outbreaks of drug-resistant tuberculosis, and these outbreaks ceased when ART was scaled up in those settings. There are currently HIV-associated epidemics of multi-drug resistant TB (MDR-TB) in South Africa, Eastern Europe and central Asia.
Matteeli reviewed the important studies conducted in recent years including SAPIT and STRIDE that demonstrate the importance of beginning ART in HIV co-infected patients during TB treatment. He also highlighted the 2011 World Health Organization guidance on HIV/TB co-infection calling for implementation of the three “Is” – intensified case finding, isoniazid preventive therapy (IPT) for persons with HIV who do not have TB disease, and infection control. ART is critical but requires rapid HIV diagnosis, rapid CD4 determination and the availability of ART. Health care workers also need training on how to identify and manage immune reconstitution syndrome—a frequent outcome of administering ART in patients with HIV and TB disease.
Treatment access for MDR-TB remains poor in most parts of the world and diagnostic capability is very poor. Only seven percent of the world has adequate capacity to diagnose MDR-TB. Cepheid’s GeneXpert rapid TB diagnostic is an important new tool and needs to be made more widely available. Matteeli also called for a substantial investment in laboratory infrastructure in countries with high rates of TB and HIV.
In other news relevant to tuberculosis and TB/HIV co-infection, results from a large, prospective study were just released evaluating the efficacy of GeneXpert in diagnosing tuberculosis in children. The study found that GeneXpert was substantially more effective in diagnosing TB in children than sputum microscopy. Notably, GeneXpert was even more effective in diagnosing TB in HIV-infected children than in HIV uninfected children.