0
Special Communication |

Opportunities and Challenges for HIV Care in Overlapping HIV and TB Epidemics

Diane V. Havlir, MD; Haileyesus Getahun, MD, PhD, MPH; Ian Sanne, MBBCH, FCP(SA); Paul Nunn, MD, FRCP
JAMA. 2008;300(4):423-430. doi:10.1001/jama.300.4.423.
Text Size: A A A
Published online

Tuberculosis (TB) and the emerging multidrug-resistant TB epidemic represent major challenges to human immunodeficiency virus (HIV) care and treatment programs in resource-limited settings. Tuberculosis is a major cause of mortality among patients with HIV and poses a risk throughout the course of HIV disease, even after successful initiation of antiretroviral therapy (ART). Progress in the implementation of activities directed at reducing TB burden in the HIV population lags far behind global targets. HIV programs designed for longitudinal care are ideally suited to implement TB control measures and have no option but to address TB vigorously to save patient lives, to safeguard the massive investment in HIV treatment, and to curb the global TB burden. We propose a framework of strategic actions for HIV care programs to optimally integrate TB into their services. The core activities of this framework include intensified TB case finding, treatment of TB, isoniazid preventive treatment, infection control, administration of ART, TB recording and reporting, and joint efforts of HIV and TB programs at the national and local levels.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Figure. Schematic of Risk of TB and Change in CD4 Cell Count From Onset of HIV Seroconversion
Graphic Jump Location

TB indicates tuberculosis; ART, antiretroviral therapy; HIV, human immunodeficiency virus. Schematic of risk of TB and CD4 cell count decline from onset of HIV seroconversion until 6 years after ART initiation for an individual living in a TB endemic area. This hypothetical individual presents to HIV care and starts ART when the CD4 cell count is 100 cells/μL. Fold change risk of TB is relative to HIV-uninfected population. Schema is based on data from published cohort studies.713

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 47

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
The dynamics of tuberculosis epidemiology. Indian J Tuberc 2014;61(1):19-29.
The HIV Epidemic in Eastern Europe and Central Asia. Curr HIV/AIDS Rep Published online Mar 21, 2014.;
Jobs
JAMAevidence.com
brightcove.createExperiences();