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June 8, 1999

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Report: Tuberculosis Control Programs Inadequate in Developing Countries

Swelling HIV infection rates continue driving a tuberculosis epidemic in sub-Saharan Africa, and world health policy makers need to better account for the intertwining of the two diseases, say Johns Hopkins researchers in a new report. Tuberculosis in the HIV-infected presents a challenge much different than tuberculosis among the HIV-negative, they add, but current efforts by the World Health Organization and by individual countries do not address these differences.

"If decision-makers ignore the clear trends in sub-Saharan Africa and continue with current approaches, the tuberculosis situation in countries with high rates of HIV is likely to worsen," says Richard E. Chaisson, M.D., an author of the report in the June International Journal of Tuberculosis and Lung Disease.

Chaisson and co-author Kevin De Cock of the Centers for Disease Control and Prevention point to the examples of New York City and Baltimore, which in recent years implemented policies that decreased the incidence of tuberculosis among high-risk groups, including those with high rates of HIV infection. Similar measures could reduce the rate of tuberculosis transmission among the large HIV-infected population of Africa as well, Chaisson says. According to the World Health Organization, two-thirds of the world's HIV-positive population, or more than 20 million people, live in sub-Saharan countries like Kenya and Zimbabwe. An estimated one-quarter to one-half of them are co-infected with tuberculosis.

An infection caused by mycobacterium, tuberculosis is transmitted through the air and kill more people worldwide than any other infectious disease. Because HIV weakens the immune system and leaves patients susceptible to the tuberculosis bug, the wet, persistent coughing and cold night sweats tuberculosis brings on are often the first clinical signs of AIDS. Moreover, tuberculosis in much more deadly in people with HIV and is the leading cause of death in that population.

Specific recommendations from the report:

Relevant Web sites:

An abstract of the report is available at http://www.iuatld.org
Tuberculosis summary and statistics, compiled by Chaisson -- http://www.hopkins-id.edu/diseases/tb/index_tb.html
World Health Organization tuberculosis fact sheet -- http://www.who.int/gtb/publications/factsheet/index.htm

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