TB/HIV facts 2012-2013

The challenge

  • At least one-third of the 34 million people living with HIV worldwide is infected with latent TB. Persons co-infected with TB and HIV are 21-34 times more likely to develop active TB disease than persons without HIV.
  • TB is the most common presenting illness among people living with HIV, including those who are taking antiretroviral treatment. There were an estimated 1.1 million HIV positive new TB cases globally in 2011. Around 79% of patients live in sub-Saharan Africa.
  • TB is the leading cause of death among people living with HIV, accounting for one in four HIV-related deaths. In 2011 some 430 000 people died of HIV-associated TB. Although globally the numbers of HIV-associated TB deaths were similar among men and women in 2011, in the African region more deaths are estimated to have occurred among women than men, whilst in other regions more deaths are estimated to occur in men.
  • People living with HIV are facing emerging threats of drug-resistant TB such as multi-drug resistant (MDR-TB) and extensively drug resistant TB (XDR-TB). Worldwide, there were an estimated 310 000 MDR-TB cases among notified TB patients with pulmonary TB in 2011.

The response

  • Routine HIV testing should be offered to all patients with presumptive and diagnosed TB. Globally in 2011, 40% of TB patients (2.5 million) were tested for HIV and accessed HIV prevention, treatment and care services, up from 33% (2.1 million in 2010).
  • Antiretroviral therapy (ART) and Co-trimoxazole preventive therapy (CPT) should be given to all TB patients living with HIV, irrespective of their CD4 counts. Of the TB patients who were known to be HIV positive in 2011, 48% (over 258 000) were enrolled on ART and 79% (410 000) were enrolled on CPT.
  • The Three I’s for HIV/TB (Intensified case finding for TB, Isoniazid preventive therapy (IPT), and Infection control) will reduce the burden of TB among people living with HIV and therefore must be urgently implemented by all HIV services.
  • The number of people living with HIV who were screened for active TB (an element of "intensified case finding") increased from 2.3 million in 2010 to 3.2 million in 2011, representing less than 10% of the 34 million people estimated to be living with HIV. Once active TB is ruled out, people living with HIV should receive IPT. Among the 29 countries that reported data for 2011, IPT was provided to 446 000 people living with HIV more than double the 201 000 receiving it in 2010. TB infection control measures are still not implemented in many HIV service settings.
  • People living with HIV need early diagnosis and treatment of active TB disease. Xpert MTB/RIF rapid test is recommended as the initial diagnostic test for people living with HIV who have suspected TB.

WHO'S role in response to TB/HIV

WHO guides policy development and planning

WHO builds capacity

WHO builds capacity through technical assistance and support to national initiatives to expand quality services and vital infrastructure for TB/HIV diagnosis and treatment.

  • WHO provides global and front-line support including training of national authorities, partners and consultants for faster response to expressed need. This is provided through WHO TB and HIV staff in six regional offices and 45 countries (though limited resources mean demand outstrips supply).

WHO strengthens collaboration

WHO strengthens collaboration so that a wider array of partners share lessons learnt thus solving operational problems and giving demand-driven support to countries and communities.

  • WHO hosts the Stop TB Partnership secretariat as well as providing the staffed secretariat for the TB/HIV Working Group of the Stop TB Partnership
  • WHO works with funding partners such as PEPFAR and The Global Fund and many HIV and TB technical agencies to increase support to high burden countries to scale-up implementation of TB/HIV collaborative activities.

WHO monitors and evaluates

WHO monitors and evaluates global, regional and national control efforts.

  • WHO's annual Global TB Control Report and the Progress Report on the HIV/AIDS Response include key performance indicators on collaborative TB/HIV activities.
  • WHO and the TB/HIV Working Group stimulate and conduct TB/HIV operational research