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Global Trends and Interactions With the HIV Epidemic

Elizabeth L. Corbett, PhD; Catherine J. Watt, DPhil; Neff Walker, PhD; Dermot Maher, BM, BCh; Brian G. Williams, PhD; Mario C. Raviglione, MD; Christopher Dye, DPhil

Arch Intern Med. 2003;163:1009-1021.

Background  The increasing global burden of tuberculosis (TB) is linked to human immunodeficiency virus (HIV) infection.

Methods  We reviewed data from notifications of TB cases, cohort treatment outcomes, surveys of Mycobacterium tuberculosis infection, and HIV prevalence in patients with TB and other subgroups. Information was collated from published literature and databases held by the World Health Organization (WHO), the Joint United Nations Programme on HIV/Acquired Immunodeficiency Syndrome (UNAIDS), the US Census Bureau, and the US Centers for Disease Control and Prevention.

Results  There were an estimated 8.3 million (5th-95th centiles, 7.3-9.2 million) new TB cases in 2000 (137/100 000 population; range, 121/100 000-151/100 000). Tuberculosis incidence rates were highest in the WHO African Region (290/100 000 per year; range, 265/100 000-331/100 000), as was the annual rate of increase in the number of cases (6%). Nine percent (7%-12%) of all new TB cases in adults (aged 15-49 years) were attributable to HIV infection, but the proportion was much greater in the WHO African Region (31%) and some industrialized countries, notably the United States (26%). There were an estimated 1.8 million (5th-95th centiles, 1.6-2.2 million) deaths from TB, of which 12% (226 000) were attributable to HIV. Tuberculosis was the cause of 11% of all adult AIDS deaths. The prevalence of M tuberculosis–HIV coinfection in adults was 0.36% (11 million people). Coinfection prevalence rates equaled or exceeded 5% in 8 African countries. In South Africa alone there were 2 million coinfected adults.

Conclusions  The HIV pandemic presents a massive challenge to global TB control. The prevention of HIV and TB, the extension of WHO DOTS programs, and a focused effort to control HIV-related TB in areas of high HIV prevalence are matters of great urgency.

From the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, England (Dr Corbett); World Health Organization, Geneva, Switzerland (Drs Watt, Williams, Raviglione, and Dye, and Dr Maher); and the Joint United Nations Programme on AIDS, Geneva, Switzerland (Dr Walker). The authors have no relevant financial interest in this article.

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