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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.
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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.

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

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