Tuberculosis and HIV Co-infection (TB and HIV)

______________

Dr Harriet Nakigozi

By Dr Harriet Nakigozi

Tuberculosis (TB) is an infectious disease that most often affects the lungs. TB is the second leading infectious killer after COVID-19 (above HIV and AIDS). It is caused by a type of bacteria called Mycobacterium Tuberculosis (MTB).

A total of 1.3 million people died from TB in 2022 (including 167 000 people with HIV). Worldwide. Uganda is among the 30 high burdened TB countries in the World.

In 2022, an estimated 10.6 million people fell ill with tuberculosis (TB) worldwide, including 5.8 million men, 3.5 million women and 1.3 million children. About 167 000 people died of HIV-associated TB. The percentage of notified TB patients who had a documented HIV test result in 2022 was 80%, up from 76% in 2021.

People living with HIV are 16 (uncertainty interval 14–18) times more likely to fall ill with TB disease than people without HIV.

TB is the leading cause of death among people with HIV.

HIV and TB form a lethal combination, each speeding the other's progress. Without proper treatment, 60% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die.

The WHO African Region has the highest burden of HIV-associated TB. Overall in 2022, only 54% of TB patients known to be living with HIV were on antiretroviral therapy (ART).

WHO recommends a 12-component approach of collaborative TB-HIV activities, including actions for prevention and treatment of infection and disease, to reduce deaths.

Impact

• Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk.
• Over 80% of cases and deaths are in low- and middle-income countries.
• TB occurs in every part of the world.
• In 2022, the largest number of new TB cases occurred in WHO South-East Asian Region (46%), is followed by the African Region (23%) and the Western Pacific (18%).
• Around 87% of new TB cases occurred in the 30 high TB burden countries, with more than two-thirds of the global total in Bangladesh, China, Democratic Republic of the Congo, India, Indonesia, Nigeria, Pakistan and the Philippines.
• Globally, about 50% of TB patients and their households face total costs (direct medical expenditures, non-medical expenditures and indirect costs such as income losses) that are catastrophic (>20% of total household income), far from the WHO End TB Strategy target of zero.
• Those with compromised immune systems, such as people living with HIV, under nutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.
• Globally in 2022, there were 2.2 million new TB cases that were attributable to under nutrition, 0.89 million to HIV infection, 0.73 million to alcohol use disorders, 0.70 million to smoking and 0.37 million to diabetes
• US$ 13 billion are needed annually for TB prevention, diagnosis, treatment and care to achieve global targets agreed on at the UN high level-TB meeting. 
• As in the past decade, most of the spending on TB services in 2022 (80%) was from domestic sources.
• In low- and middle-income countries, international donor funding remains crucial. The main source is the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The United States Government is the largest contributor of funding to the Global Fund and also the largest bilateral donor.
• For research and development, according to the Treatment Action Group, only US$ 1 billion were available in 2022 of the US$ 2 billion required per year to accelerate the development of new tools. At least an extra US$ 1 billion per year is needed to accelerate the development of new tools. 

 WHO Response

• WHO is working closely with countries, partners and civil society in scaling up the TB response. There are Six core functions being pursued by WHO to contribute to achieving the targets of the UN high-level meeting political declaration, Sustainable Development Goals, End TB Strategy and WHO strategic priorities:
• Providing global leadership to end TB through strategy development, political and multisectoral engagement, strengthening review and accountability, advocacy, and partnerships, including with civil society.
• Shaping the TB research and innovation agenda and stimulating the generation, translation and dissemination of knowledge.
• Setting norms and standards on TB prevention and care and promoting and facilitating their implementation
• developing and promoting ethical and evidence-based policy options for TB prevention and care.
• Ensuring the provision of specialized technical support to Member States and partners jointly with WHO regional and country offices, catalysing change, and building sustainable capacity and monitoring and reporting on the status of the TB epidemic and progress in financing and implementation of the response at global, regional and country levels.