TB and HIV Coinfection: Current Trends, Diagnosis and Treatment Update

17 the impact that hiv has on the pathogenesis of tuberculosis (tb) is clear. It is one of the most important risk factors associated with an increased risk of latent tb infection (ltbi) progressing to active tb disease. hiv-infected people have an annual risk of 5% to 15% of developing active tb once infected (Rieder, 1999). tb is the most common opportunistic infection in people living with hiv worldwide. It is also the most common cause of death in hiv-positive adults living in developing countries, despite being a preventable and treatable disease (Corbett, 2003). Dr. Sonal Munsiff began her April 2006 prn lecture describing the global epidemiology of tb and hiv coinfection and emphasized its relevance to New York City’s large immigrant population. Following a discussion of the current status of tb and hiv coinfected patients in New York City, she focused on the diagnosis and treatment challenges in these patients. The estimated incidence of tb remains high in both Asia and Africa, with the highest estimated incidence in sub-Saharan Africa (300 new cases per 100,000 population). “The main reason for the markedly high rates of tb in sub-Saharan Africa is the high prevalence of hiv infection,” Dr. Munsiff pointed out. “In fact, more than half of tb cases in many subSaharan African countries are in hiv-infected persons. The aids epidemic has caused marked acceleration of the tb epidemic worldwide and in sub-Saharan Africa, in particular” (see Figure 1). The Stop tb Partnership recently released a ten-year plan to address the global tb epidemic (Stop tb Partnership, 2006). While this plan aims to reduce the global burden of tb, Dr. Munsiff noted that even if all aspects of the plan are implemented and fully funded, a decrease in tb incidence in African countries with high hiv prevalence in the next ten years is probably unlikely based on current trends. While tb and hiv co-infection remains a major public health problem in many parts of the world, the number of tb cases coinfected with hiv in the United States has been decreasing. The number of tb cases has been declining since 1992, and the prevalence of tb and hiv coinfection has reached a somewhat steady state. According to the U.S. Centers for Disease Control and Prevention (cdc), approximately 10% of all tb cases in the US are also co-infected with hiv (cdc, 2004).