Latest in HIV/TB research

With HIV infection driving a deadly resurgence of tuberculosis (TB), a new publication provides up-to-date recommendations for clinicians facing the many challenges of treating patients with both of these two complex diseases.

The publication, a supplement to the August 15 issue of The Journal of Infectious Diseases, is now available online.

The supplement also provides important guidance for meeting the urgent challenge of integrating TB and HIV research and treatment programs. It is being published as the world's top HIV/AIDS experts gather in Sydney, Australia for the 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment, and Prevention, where a satellite symposium on integrating HIV and TB research programs will take place.

TB, one of humanity's oldest afflictions, claims an estimated 2 million lives each year. HIV disease, one of humanity's newest, kills approximately 3 million people per year. They are the world's two leading infectious diseases-related causes of death, and TB is the leading cause of death among people with HIV. The twin pandemics compound each other with devastating effects, with one infection accelerating and complicating the treatment of the other. Furthermore, highly virulent, multidrug- and extensively drug-resistant forms of TB are emerging that threaten to turn the HIV/TB co-pandemics from an emergency to a disaster.

"Our aim was to provide an up-to-date map of the terrain at the confluence of the world's two deadliest plagues," said Gerald Friedland, MD, at the Yale University School of Medicine AIDS Program and lead guest editor of the supplement. "The supplement lays out the state of our knowledge in diagnosis, treatment, and prevention, and defines what is terra incognita."

Furthermore, the people and places hardest hit by both diseases are the least able to cope with either. HIV/TB coinfection has overwhelmed public health, medical, and social systems in developing-world countries with limited resources. The supplement focuses on sub-Saharan Africa, where the parallel pandemics have hit hardest.

"Unfortunately, these pandemics are parallel in more ways than one," said Veronica Miller, PhD, director of the Forum for Collaborative HIV Research, one of the lead sponsors of the supplement, and research professor at The George Washington University. "The two disciplines are like the two rails of a train track: experts are traveling the same route but their paths rarely cross. The scope of the crisis makes it imperative that HIV and TB research and treatment programs work together. We hope this supplement helps to point the way to closer integration."

To further this goal, the Forum for Collaborative HIV Research is co-hosting a major symposium at the IAS Conference. Entitled, "HIV/TB Co-Infection: Meeting the Challenge." The symposium will highlight research gaps at the juncture of the two epidemics and identify ways to fill those gaps. Symposium co-sponsors include the WHO HIV/TB Working group and others.

Key articles in the supplement include:

• Treatment options for patients with HIV and TB, including articles on current recommendations; complications due to drug interactions, toxicities, and the reconstruction of an HIV-damaged immune system; new drugs in development; and important unanswered questions regarding treatment
• Needs and opportunities for new diagnostic tools
• TB prevention for people with HIV, including an article on controlling the spread of TB infection among immunosuppressed patients attending HIV programs
• Case studies on integrating HIV and TB programs
• Special issues for diagnosing and managing TB in children with HIV