Format

Send to

Choose Destination
Presse Med. 2017 Mar;46(2 Pt 2):e23-e39. doi: 10.1016/j.lpm.2017.01.017. Epub 2017 Feb 28.

The cursed duet today: Tuberculosis and HIV-coinfection.

Author information

1
Barts health NHS trust, Royal London hospital, division of infection, 80, Newark street, E1 2ES London, United Kingdom. Electronic address: simon.tiberi@bartshealth.nhs.uk.
2
Oswaldo Cruz institute (IOC), laboratory of innovations in therapies, education and bioproducts, (LITEB), Fiocruz, Rio de Janeiro, Brazil. Electronic address: anna.carvalho@ioc.fiocruz.br.
3
University of Brescia, university department of infectious and tropical diseases, World health organization collaborating centre for TB/HIV co-infection and TB elimination, Brescia, Italy. Electronic address: g.sulis@unibs.it.
4
Barts Health NHS Trust, Royal London hospital, department of respiratory medicine, 80, Newark street, E1 2ES London, United Kingdom. Electronic address: devan.vaghela@bartshealth.nhs.uk.
5
Hospital universitario de Monterrey, centro de investigación, prevención y tratamiento de infecciones respiratorias, Monterrey, Nuevo León UANL, Mexico. Electronic address: adrianrendon@hotmail.com.
6
Federal university of Rio de Janeiro, instituto de Doenças do Tórax (IDT)/Clementino Fraga Filho hospital (CFFH), rua Professor Rodolpho Paulo Rocco, n° 255 - 1° Andar - Cidade Universitária - Ilha do Fundão, 21941-913, Rio De Janeiro, Brazil. Electronic address: fcqmello@idt.ufrj.br.
7
Papworth hospital NHS foundation trust, department of respiratory medicine, Papworth Everard, Cambridge, United Kingdom. Electronic address: anannarahman@nhs.net.
8
Barts Health NHS Trust, Royal London hospital, HIV medicine, infection and immunity, London, United Kingdom. Electronic address: Nashaba.Matin@bartshealth.nhs.uk.
9
UCL hospitals NHS Foundation Trust, university college London, NIHR biomedical research centre, division of infection and immunity, London, United Kingdom. Electronic address: a.zumla@ucl.ac.uk.
10
Galliera hospital, department of infectious diseases, Genoa, Italy. Electronic address: pontals@yahoo.com.

Abstract

The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.

PMID:
28256380
DOI:
10.1016/j.lpm.2017.01.017
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center