Issues
HIV/AIDS
Tuberculosis (TB)
HIV/TB Co-infection
HIV/AIDS
Antiretroviral therapy (ART) has transformed HIV/AIDS from a fatal disease to a chronic illness for many patients in the developed world. And across the globe, there has been a dramatic increase in recent years in the number of HIV-positive people living active lives because of the significant scale-up of ART.
Despite that progress, the scope of the epidemic remains staggering and the unmet need immense. HIV/AIDS is the world’s most deadly infectious disease. About 2 million people died of AIDS in 2007, including 270,000 children.
An estimated 33 million people were living with HIV at the end of 2007, and only one third of those eligible for ART were actually getting it. Furthermore, for every one person put on treatment, there are five new infections; 2.7 million people became newly infected with HIV in 2007 alone.
Many of those new infections are among infants. Only 33 percent of pregnant HIV-positive women in developing countries received drugs to block transmission of the virus to their babies in 2007, according to one estimate.
HIV/AIDS often attacks young adults, undermining families and hindering economic development. HIV also drives up the transmission of tuberculosis, a highly destabilizing threat to the developing world.
The Center’s work on HIV/AIDS is focused heavily on prevention—fostering an understanding of and support for new scientific innovations that could change the course of this deadly epidemic. New approaches to prevention are within reach--from male circumcision to the preventive use of antiretroviral drugs. But successful implementation of those innovations will require leadership, commitment and resources.
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Tuberculosis (TB)
Tuberculosis (TB) is sometimes a forgotten, neglected disease. But an estimated one-third of the world’s population is infected with the bacterium that causes TB. TB is the second most deadly infectious disease worldwide; it kills more than 1.7 million people each year—almost as many as HIV/AIDS.
In 2007, an estimated 9.3 million new TB cases were detected, and a large proportion of people with active TB disease go untreated each year.
In addition, drug-resistant strains of TB are on the rise. Some 5 percent of TB cases–nearly half a million–are multidrug-resistant (MDR-TB) and an estimated 40,000 cases of extensively-drug resistant TB, or XDR-TB, emerge each year. Both MDR and XDR-TB are extremely difficult and costly to treat. XDR-TB is often incurable.
The diagnostics and drugs currently available to treat are TB no a match for the current threat. They are woefully outdated and often ineffective against the drug-resistant strains of the disease. The most recent TB drug came to market more than two decades ago; the most common test used to diagnose TB is more than a century old, and it cannot distinguish between drug-susceptible and drug-resistant TB.
The Center’s work on tuberculosis aims to build support for a reinvigorated TB agenda, pressing for new attention to prevention and treatment, as well as enhanced resources for scientific research in pursuit of more effective TB drugs, diagnostics, and an effective TB vaccine.
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HIV/TB Co-infection
HIV/AIDS and tuberculosis have formed a deadly alliance that speeds the development of both diseases and threatens to unravel the fragile gains made in the twin battles against these two epidemics.
Co-infection with HIV and TB, if untreated, puts patients at high risk of a quick and painful death. TB is the most common opportunistic infection—and the leading cause of death—among people with HIV. An HIV-positive person with latent TB has a 5 to 10 percent chance of developing TB disease annually and is 20 to 30 times more likely to develop TB than those without HIV. Conversely, having TB disease accelerates the progression of HIV/AIDS.
The consequences of co-infection are dire:
it threatens to reverse the progress made in fighting the global AIDS epidemic, potentially jeopardizing the historic roll-out of antiretroviral drugs in the developing world,
and it threatens to undo decades of work in TB control and prevention, creating an environment for this ancient disease to thrive once again, often in new virtually untreatable forms.
The scope of the co-infection epidemic is staggering. At least one-third of the 33 million people living with HIV across the globe are also infected with TB, according to the World Health Organization (WHO). In 2007, there were an estimated 1.37 million new cases of HIV/TB co-infection in 2007, with 456,000 deaths.
In the last two decades, the number of new TB cases has tripled in high HIV prevalence countries, according to WHO. Approximately 80 percent of co-infected patients live in sub-Saharan Africa. Ninety percent of TB patients in Lesotho are co-infected with HIV. In Botswana, eighty percent of new adult TB cases occur among people with HIV. In South Africa, 44 percent of new adult TB cases emerge in those with HIV.
So far, the response to this co-infection epidemic has been woefully inadequate; basic screening and prevention measures are rarely undertaken, allowing the epidemic to move forward unchecked.
For example, WHO reports that in 2007, only 2.2 percent of HIV-infected patients were screened for TB; at least 14 million HIV patients should have been tested. In addition, people with HIV can be protected from TB disease for about two years if they get a daily dose of the TB drug isoniazid for six months, but this therapy has only been given to one-tenth of 1 percent of those who need it.
The Center’s goal on HIV/TB co-infection is to educate policymakers, the media, and the broader public about the extent of the threat and to press for an urgent, comprehensive response. The Center is working to build support for aggressive leadership on co-infection, including better HIV/TB program integration, more robust funding for global HIV and TB prevention and control programs, and increased resources for HIV/TB co-infection research.
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