Double scourge: tuberculosis and HIV coinfection

Wafaa El-Sadr MD, MPH

Tuberculosis (TB) has, from ancient times, ranked among the most feared and dreaded of the many diseases that afflict mankind.

More than a century since Mycobacterium tuberculosis was discovered and more than 50 years after effective drug treatment was introduced, TB remains a major public health problem. It is now five years since the World Health Organization (WHO) took the unprecedented step of declaring TB a “global emergency.” And yet more people died of TB last year than in recorded history — two to three million deaths, or one death every 10 seconds.

Eradicating TB, even within the borders of industrialized nations, continues to be a significant challenge. In 1989, the US Public Health Service Advisory Council on the Elimination of Tuberculosis was established and proposed the TB Elimination Strategy—defined as a case rate less than one per 1,000,000 people—to be completed by the year 2010. With only eight years remaining, thousands of TB cases continue to be reported annually in the United States. In turn, new recommendations toward the goal have been established, including more aggressive screening and early treatment approaches, particularly among those at the greatest risk for TB: persons living with HIV and AIDS.

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