Tuberculosis and HIV infection: partners in human tragedy.

Tuberculosis (TB) is one of medicine’s oldest plagues, and HIV infection is its newest. Together, TB and HIV infection have a synergy that clearly threatens much of the hope for conquering either plague. The science of TB and its control has been one of the greatest achievements in medicine. Robert Koch discovered the tubercle bacillus in 1882, and he succeeded in fulfilling his postulates through remarkable achievements of culture, staining, and experimental studies in animals [1]. Successful therapy began with the discovery of streptomycin in 1943 [2], and the genome of Mycobacterium tuberculosis was sequenced in 1998. TB has been a curable disease for 40 years, and a cure can now be achieved for as little as $16/patient. There are also highly effective methods to achieve TB control. Nevertheless, it has been estimated that (1) ∼30% of the global population is infected, (2) a new infection occurs every second, and (3) ∼1.7 million deaths due to TB occur every year [3, 4]. The science of HIV/AIDS has a similarly remarkable story of achievement, with the putative agent discovered in 1983, zidovudine receiving approval as the first effective antiretroviral agent in 1987, and extraordinary achievements in treatment being made since the introduction of highly active antiretroviral therapy in 1996. Despite such progress, and similar to what has been noted for TB, current estimates indicate that 39.5 mil-