Urgent action needed against ‘duo infernale’ of HIV and tuberculosis

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Tuberculosis (TB) and multi drug-resistant tuberculosis (MDR-TB) are currently experiencing a dangerous upsurge across Europe. It is a public health crisis that is receiving too little attention, write Giovanni Battista Migliori and Stefano Alberti.

Prof. Giovanni Battista Migliori and Dr Stefano Alberti are the Secretary General and Head of the Respiratory Infections Assembly of the European Respiratory Society (ERS).

In 2013, 1.1 million people living with HIV developed TB. Although TB is entirely preventable and curable, it is the most common disease among people living with HIV, including those undergoing antiretroviral therapy. It is also the leading cause of death among people living with HIV, with 360,000 estimated deaths annually.

HIV fans the flames of the TB epidemic. HIV-positive patients are anywhere from 21- to 34-times more likely to develop TB than people without HIV. As it weakens the immune system, patients with HIV are more likely to contract TB or have a flare-up of a dormant case of TB. According to the World Health Organisation (WHO), at least one-third of the 33 million people living with HIV/AIDS are already living with dormant Mycobacterium tuberculosis and are therefore at risk of developing active TB. In addition, once infected with TB, HIV makes it harder for the body to fight the damage caused by the active form of the disease. Finally, in the WHO European Region, MDR-TB is more frequently seen in HIV-positive patients, which makes successful treatment even more challenging.

So on World AIDS day – what is the solution? The European Respiratory Society (ERS) believes that successfully bringing the TB epidemic in HIV patients under control requires, among other things, the implementation of collaborative TB/HIV activities to address this devastating duo infernale. It is crucial to take TB control activities out of existing silos and address common co-morbidities such as HIV/AIDS. To that end, cost-effective technology can help transform treatment by providing opportunities to improve knowledge sharing and collaboration between clinicians across the globe.

To improve the clinical management of difficult-to-treat TB cases, WHO Europe, in collaboration with the ERS, has launched an electronic consilium (the ERS/WHO TB Consilium), involving international TB experts. The ERS/WHO TB Consilium provides scientifically sound and evidence-based clinical advice in an online forum to national consilia or individual practitioners on the management of MDR-TB cases and other difficult-to-treat TB cases, including TB/HIV cases. The ERS/WHO TB Consilium allows for the more effective management of patients, contacts of infected cases and individuals who are latently infected with Mycobacterium tuberculosis. ERS encourages the HIV expert community to use the TB Consilium to gain knowledge and to make essentially connections in the TB community.

Such initiatives need strong support from the EU institutions and, therefore, ERS encourages the future Latvian Presidency of the Council to put the dual burden of TB/HIV on their list of public health priorities. ERS also calls on the European Parliament to step-up efforts to raise awareness in the EU and press the European Commission to dedicate resources to address the duo infernale TB/HIV.