WHO global TB control report highlights that 25% of TB-related deaths occur in HIV-positive people

About one-quarter of tuberculosis-related deaths involve an HIV-positive person, twice as high as previous estimates, according to the Global Tuberculosis Control Report 2009, which the World Health Organization released on 24 March to coincide with World TB Day.

The report found a total of 9.3 million new TB cases in 2007, 1.4 million of which occurred in people living with HIV/AIDS. Kevin De Cock, HIV/AIDS director at WHO said that these new estimates do not reflect an increase HIV/TB coinfections or in TB deaths among HIV patients, but rather better analyses, better data and better methodology. In addition, increased HIV testing among TB patients has revealed cases of HIV that previously went undetected. In previous reports, WHO used data on HIV/TB coinfection from 15 countries; however, the new report includes data from 64 countries, several of which are in sub-Saharan Africa.

According to the report, 55% of recorded TB cases occurred in Asia in 2007, while 31% occurred in Africa. India had the highest number of recorded cases at two million, followed by China with 1.3 million and Indonesia with 530,000.

There were about 1.3 million TB deaths among HIV-negative people and about 456,000 among HIV-positive people in 2007. TB was the primary cause of death among people living with HIV/AIDS in 2007 and HIV-positive people are about 20 times more likely to develop TB than HIV-negative people in countries with high HIV prevalence and are between 26 and 37 times more likely to develop TB in countries with lower HIV prevalence.

The report found a significant increase in the number of HIV tests that are administered to people with TB, particularly in Africa. About 4% of TB patients in Africa were tested for HIV in 2004, compared with 37% in 2007. In several countries, more than 75% of TB patients received an HIV test, according to the report. Although efforts to address HIV/TB coinfection have improved, such efforts are inadequate in many developing countries. De Cock noted that only one in seven HIV-positive people receive preventive treatment for TB. In addition, more than one-third of TB cases worldwide are undiagnosed, increasing the risk of transmission. The report recommended that HIV-positive people receive TB screenings and medications to reduce their risk of developing the disease.

The report also found an increase in drug-resistant strains of TB in recent years. According to the report, more than 500,000 people worldwide have been diagnosed with multi-drug resistant TB. Fewer than 1% of people with MDR-TB were receiving WHO-recommended treatment in 2007. In addition, at least one case of extensively drug-resistant TB has been reported in 55 countries and territories worldwide. XDR-TB is resistant to two of the most potent first-line treatments and at least two of the classes of second-line drugs. Mario Raviglione, director of WHOs STOP TB department, added that the actual prevalence of XDR-TB likely is higher because many developing countries do not conduct tests to determine the extent of drug-resistance in TB patients.

The report also documented concern over funding in the current economic downturn, noting that 94 countries that account for 93% of all TB cases worldwide have a funding shortfall of $1.5 billion to meet the targets in the Global Plan to Stop TB 2006-2015.

Wafaa El-Sadr, a professor of medicine and epidemiology at Columbia University said the reports findings demonstrate that one cannot think of tackling or controlling the TB epidemic globally without thinking of how were going to do it in HIV-infected populations.