Treat HIV and TB together say experts

South Africa experts such as Professor Greg Hussey have repeatedly called on the South African government to treat HIV and TB together and his call was echoed by experts from around the world at the recent 38th World Lung Health Conference in Cape Town.

According to Dr Paul Fujiwara of the International Union Against Tuberculosis and Lung Disease, it's a "scandal" that not all HIV patients are being screened for TB. The Stop TB Partnership believes that 600 000 cases of TB occur in HIV-positive people each year, of whom one-third will die.

Dr Mario Raviglione, Stop TB director of WHO, says that governments should routinely report the proportion of TB patients who are co-infected with TB. Current reporting rules vary between countries. For example, in South Africa, an HIV patient who dies from TB will be reported as TB, while in Brazil the same patient would be recorded as having died of HIV-related causes.

Four areas in which health ministries need to take urgent action were highlighted by HIV and TB activists:

1. Improving infection control to prevent infections in health care settings, especially where large numbers of HIV-positive people are concentrated.

2. Testing more people with HIV for TB, and vice versa.

3. Integrating and decentralising TB and HIV services.

4. Preventing and treating drug-resistant TB.

The South African government announced on Thursday that it is committing an extra R400 million to drug resistant TB, but activists say that this is at least one year too late. South African and international experts began to call for greater investment in drug-resistant TB in September 2006 after the international medical community learnt of an outbreak of extensively drug-resistant TB in rural KwaZulu Natal, the South African province most severely affected by HIV and TB. They also highlighted chronic underinvestment in health services and TB control, which has led to a lack of hospital beds to treat multi-drug resistant TB patients in isolation.

The developing world could also prevent TB in HIV-positive patients by the simple measure of introducing isoniazid prophylaxis - proven to work and very low cost, according to Dr Paula Fujiwara. At present, Botswana is the only country to introduce this measure.