Update: A full video of the briefing appears at the bottom of the post.
Leading disease experts made a compelling case for strong US leadership and aggressive new policies to combat HIV/TB co-infection at a congressional briefing on Thursday. The briefing came in conjunction with the release of a new report, “Deadly Duo: The Synergy Between HIV/AIDS & Tuberculosis,” from the Center for Global Health Policy.
The central message of both the report and Thursday’s presentations was simple: the incredible success in treating HIV with antiretroviral therapy is at risk because of tuberculosis. The number of new TB cases has tripled in high HIV-prevalence countries over the last two decades, and TB is the No. 1 killer of people with HIV in the developing world.
“TB is the greatest threat to the miracle of HIV therapy,” said Diane Havlir, MD, a professor of medicine at the University of California, San Francisco, and chief of the HIV/AIDS Division and Positive Health Program at San Francisco General Hospital. Dr. Havlir also serves on the Center for Global Health Policy’s Scientific Advisory Committee.
Dr. Havlir described the incredibly efficient and destructive alliance that HIV & TB have formed; within two weeks of becoming infected with HIV, Dr. Havlir said, a patient’s risk of getting TB goes up two-fold.
Dr. Havlir said it is vital to continue the historic scale-up of antiretroviral therapy that has come about, in large measure, because of the President’s Emergency Plan for AIDS Relief (PEPFAR). The earlier an HIV patient starts ART, she said, the less risk they will have of developing TB disease.
At a time when the scientific and medical community is already debating whether to introduce ART earlier in HIV-positive patients because of evidence that it improves survival rates, Dr. Havlir said that such a move would have a significant additional benefit: reducing the risk of TB disease and TB mortality.
Carol Dukes Hamilton, MD, co-chair of the Center’s Scientific Advisory Committee and a senior director of research at Family Health International, explained why TB is still a major world-wide threat, even though doctors have known for decades how to identify and cure this ancient bug.
The most common TB test, Dr. Hamilton noted, involves coughing into a cup and looking at the specimen under a microscope—a method that only catches about half of all active TB cases. This test is even more ineffective in patients with HIV, she noted, who often develop TB outside the lungs.
“This test is just not good enough,” Dr. Hamilton said. “We need a better diagnostic that will pick up 90-plus percent cases instead of less than 50 percent.”
Instead, she told the story of a Kenyan man named Patrick, a school teacher who had suffered two bouts of TB before being tested for a drug-resistant strain of the disease. In Kenya, there are no labs to test for drug-resistant TB, so his specimen was sent to Australia.
When the results came back positive several weeks later, he discovered that there was only one international agency in Kenya that could provide the drugs he would need to treat his disease. To be eligible, he had to live in a slum, so he left his wife and child and their modest house. He also lost his job, because there was no school in the slum for him to teach at; that meant his family also lost his income.
Another man Mburu’s agency tried to help was even less fortunate. The man, named Opiyo, called KANCO when he had trouble getting medical care at a local hospital. Mburu said Opiyo, who was HIV positive, did not have enough money for a TB test that doctors said he needed.
They helped him pay for the test. But a week later, while he was still awaiting the results, Opiyo died.
“People are living with HIV, but it is TB that is killing them,” she said.
Christine Lubinski, the Center’s director and vice president for global health at the Infectious Diseases Society of America, closed the session with an urgent call to action.
She said the US has the right leadership in place—from the CDC’s new chief, Tom Frieden, to the new Global AIDS Coordinator, Eric Goosby. And it has the legislative and program architecture in place, with PEPFAR and other initiatives.
“What’s needed now is to reinvigorate the energy [and] the passion” that HIV/AIDS activists so successfully marshalled in pushing for an aggressive research and policy response to that epidemic.
She called for an array of steps, from the continued scale-up of ART to significant new investments for research into new tools to combat TB.