Washington File - January 21, 2004

TB/HIV co-infection affects 14 million people, with 70 percent of those cases in Africa. Tuberculosis is among the most common opportunistic infections that attacks an individual whose immune system is left vulnerable by HIV. Some 80 percent of TB patients are HIV infected, according to WHO, and the lung disease affects about half of all people with HIV.

Screening and testing patients to properly identify who is infected with one or both of the conditions is a key element in the new initiative. Incorporating HIV testing into mainstream health programs treating TB patients will identify more people for treatment with antiretroviral drugs (ARVs). Those medicines can also help stop the development of TB in people who are HIV positive.

A detailed explanation of the new policy is available at http://www.who.int/gtb/publications/tb_hiv/2004_330/pdf/interim_policy.pdf

The following is the text of the WHO press release:

World Health Organization

WHO pushing to rapidly scale-up measures to fight TB and HIV

Collaborative approach to speed distribution of AIDS treatment and reduce spread of tuberculosis in high HIV prevalence areas

21 January 2004 , GENEVA -- The World Health Organization (WHO) announced today a plan to expand collaboration between national tuberculosis and HIV/AIDS programmes to curb the growing pandemic of TB/HIV co-infection, with a principal focus on Africa where 70% of the world's 14 million people who are co-infected live.

The new policy guidelines define activities necessary to address the dual epidemic of TB and HIV and gives clear guidance for countries on the circumstances under which these effective activities need to be carried out. It will give critical support for "3 by 5", the WHO plan to provide antiretroviral (ARV) treatment to three million people living with AIDS by the end of 2005."TB/HIV is a deadly combination and needs to be tackled with an approach treating the whole person," said Dr. LEE Jong-wook, Director-General of the World Health Organization. "With effective treatment, TB can be cured, HIV managed, and the health of millions of people preserved."

A key element will be to rapidly expand voluntary HIV testing and counselling in TB programmes, with the aim of identifying and referring more than half a million TB patients who are HIV positive for ARV treatment in the next two years. With additional training for health workers, TB programmes will also assist in HIV prevention, ARV distribution and patient care.

At the same time, TB case-finding will be intensified in high HIV prevalence settings by introducing screening and testing for tuberculosis into HIV/AIDS service delivery points. In Africa, up to half of all people with HIV/AIDS develop TB, and up to 80% of tuberculosis patients are HIV infected.

By routinely screening and testing people with HIV/AIDS for TB, co-infected cases, without TB disease, can be treated with prophylactic drugs that prevent development of active tuberculosis, and cured if they already have it. This will prolong the lives of people with HIV/AIDS until they can benefit from the expanded availability of ARVs in the coming years.

UNAIDS Executive Director, Dr. Peter Piot, said: "TB is perhaps the greatest and most deadly opportunistic infection associated with AIDS. By tackling TB and HIV together, we can have a significant impact on improving the quality of life of people infected with HIV, while also controlling TB and preventing new infections."

The vast majority of HIV-infected people do not know their HIV status and seek health care from general service providers. HIV testing and counselling for TB patients using rapid tests offers an entry point for a continuum of prevention, care, support and treatment for HIV/AIDS as well as for tuberculosis.

"Evidence has shown that the uptake of HIV testing by TB patients is high, so mainstreaming HIV testing and counselling into TB programmes will identify many more candidates for ARV treatment," said Dr. Mario Raviglione, the Director of WHO's Stop TB Department. "We also know that ARVs reduce the development of TB in people with HIV, in some cases by up to 80%. So promoting and expanding a collaborative approach makes perfect sense."

The launch of the "Interim Policy on Collaborative TB/HIV Activities" guidelines coincides with the fourth round call for proposals by the Global Fund to Fight AIDS, TB and Malaria. The deadline for submissions is April 2004. The interim policy will enhance proposals which address the dual epidemic of TB and HIV. Already, the Global Fund has committed US$ 2.1 billion over two years to programmes in 120 countries.

Taken together, the two epidemics represent a massive challenge to public health. Forty million people are currently infected with HIV, and 5 million more are infected every year. According to WHO, one third of the world's population is now infected with the TB bacillus, with more than 8 million people developing the active disease and 2 million dying of it each year.

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