TB and HIV double burden

A common cause of death and hospitalisation for people living with HIV is tuberculosis (TB). According to the United Nations Programme on HIV/AIDS (UNAIDS), TB was responsible for 30% of AIDS-related deaths in 20191.

The good news is that TB is curable and preventable and South Africa has made much progress in implementing effective strategies.

TB preventive treatment reduces the risk of developing TB disease and can reduce deaths among people living with HIV by almost 40%1. South Africa’s first national TB Prevalence Survey was published in 2021. According to the report, South Africa ranked eighth among the top 30 high TB burden countries in the world, which combined, contributed to 87% of the estimated incident TB cases worldwide. The country accounts for 3% of cases globally. Among the high multidrug-resistant TB (MDR-TB) burden countries, South Africa is ranked ninth2,5.

HIV/TB co-infection

People with HIV are at 18 times greater risk for incident TB than people without HIV. The 2019 Global TB report showed that the HIV co-infection rate among notified TB cases in South Africa was 59%3.

Since 2011, the World Health Organization (WHO) has recommended that all people with HIV should be systematically screened for TB at each visit to a health facility. The recommendation is based on the high risk of this group for TB and mortality and a lingering gap in case detection in this population. Early detection and timely treatment of TB among people living with HIV is critical for reducing mortality3.

The prevention of TB and other opportunistic infections, in the case of people living with advanced HIV infection, saves lives8.

References

  1. UNAIDS (2021). Huge gaps in TB care for people living with HIV in some countries. https://www.org/en/ resources/presscentre/featurestories/2021/march/20210324_ huge-gaps-tb-care
  2. SAMRC (2021). The First National TB Prevalence Survey | South Africa https://www.samrc.ac.za/media-release/ first-south-african-national-tb-prevalence-survey-gives- clearer-picture-epidemic
  3. WHO (2021). Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. https://www.who.int/publications/i/item/9789240022232
  4. National Department of Health. 2019 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy, Adolescents, Children, Infants and Neonates. Updated: March 2020.
  5. UNAIDS. South Africa tuberculosis roadmap overview, fiscal year 2021. https://www.usaid.gov/global-health/health- areas/tuberculosis/resources/news-and-updates/global- accelerator-end-tb/tb-roadmaps/south-africa
  6. Bekker L-G, Brown B, Joseph-Davey D, et al. Southern African guidelines on the safe, easy and effective use of pre-exposure prophylaxis: Southern African Journal of HIV Medicine, 2020. Ndjeka N on behalf of the Bedaquiline Implementers of the South African National TB Programme. Conference of Retroviruses and Opportunistic Infections, 2016. https:// www.croiconference.org/abstract/incorporation-bedaquiline- south-african-national-tb-programme/
  7. Hardy G. Improving tuberculosis prevention in South Africa. De Novo Medical, 2021.
  8. The TEMPRANO ANRS 12136 Study Group. A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. NEJM, 2015.
  9. Rabie H, Denti P, Lee J et al. Lopinavir-ritonavir super- boosting in young HIV-infected children on rifampicin-based tuberculosis therapy compared with lopinavir-ritonavir without rifampicin: a pharmacokinetic modelling and clinical study. Lancet HIV, 2018.