Tuberculosis in the HIV / AIDS era: interactions, impacts and solutions

Tuberculosis (TB) is a health problem of global significance, with 2 billion people infected with the tubercle bacillus and 8 million new cases each year, of which approximately 2.5 million die. TB accounts for an estimated 7% of all avoidable adult deaths worldwide. In 1995, there were an estimated 1.5 million new cases of TB in sub-Saharan Africa; the annual caseload is projected to grow to 2.1 million by 2000. The growth in population and poverty, as well as the HIV/AIDS epidemic, are behind the rise in TB cases. Countries with high rates of HIV infection have reported far faster increases in cases than those with low rates of infection, rates of HIV infection among TB patients are much higher than the rate of infection in the general population, and TB has become the most important opportunistic disease and one of the most important causes of death among HIV-positive patients in Africa. The link between the HIV/AIDS and TB epidemics, how TB makes HIV both a public and individual health problem, challenges for health services, TB treatment, the delivery of care, prevention, developing an effective response, and a future research agenda are discussed.