by Nigel Marsh - Hope Communications

BARCELONA, July 11, 2002

The number of new TB cases in Africa is increasing by 6% every year because of the HIV virus, according to the World Health Organization, which warns of a deadly cocktail in which the TB bacterium M Tuberculosis and HIV retrovirus reinforce each other's deadly effect in the population.

In the year 2000 there were an estimated 8.2m TB cases around the world, and 9% of them were due to HIV. But in Africa fully 31% of the 1.9m new TB cases in the year were attributable to AIDS. Since the mid 1980s TB notifications have risen four-fold in Malawi and Kenya, five-fold in Zambia, and seven-fold in Zimbabwe.

More than 1.8m people died of TB around the world in the year 2000, and one in eight of those cases was attributable to HIV. In Africa, 39% of the 482,000 TB deaths were AIDS-related cases. Some 30-40% of people living with AIDS who are infected with the tuberculosis bacterium develop active TB.

WHO is now calling for a new, unified approach in health interventions that will deal with TB and HIV together, replacing its previously recommended 'dual strategy'. This may lead to an extension of the successful Daily Observed Treatment System (DOTS) for tuberculosis, as a way to manage the daily application of anti-retroviral and other drugs for PLWA in places with weak health infrastructures. Prevention of HIV will become a key aspect of TB control programmes, and TB care and prevention will be a priority concern of HIV/AIDS programmes.

"TB is now a leading cause of illness and death in people with HIV, and HIV is a potent force fuelling the TB epidemic," said WHO's director of HIV/AIDS Dr Bernard Schwartlander. "The two diseases have become inseperable as public health issues, especially in Africa where they combine to most devastating effect.

"A unified approach between TB and HIV programs is essential to prevent HIV-positive people from dying of TB, and to control the surging rates of TB in HIV-positive people."

WHO partners have introduced VCT-based 'ProTEST' programs designed to jointly address TB and HIV in Malawi, South Africa and Zambia, and these will be followed by more in Ethiopia, Kenya, Mozambique, Tanzania and Uganda. The successful GFATM bid made by Ethiopia is also built around a combined approach to TB and HIV.