While TB cases are decreasing, HIV/TB coinfection cases are on the rise.
People with HIV are among those most susceptible to contracting tuberculosis (TB). A new report from the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe found that the coinfection rate of these two diseases substantially increased within five years. On the heels of World Tuberculosis Day (March 24), this is likely not the news physicians want to hear.
“The flare-up of TB/HIV co-infections from 2011 to 2015, together with persistently high rates of drug-resistant TB, seriously threaten progress made towards ending TB, the goal that European and world leaders have committed to achieve by 2030,” Zsuzsanna Jakab, PhD, () director of the WHO Regional Office for Europe, said in a news release.
The 53-country report said that new TB cases decreased by 4.3% and deaths from the lung infection decreased by 8.5% between 2011 and 2015. During this period, new TB cases and relapses decreased by 17.5%, bringing the rate from 35 to 29 cases per 100,000 population. However, the researchers explained that the rate change is mostly due to a lack of notification among the 18 high-priority countries.
“The general downward trend in reported TB cases is encouraging, but some groups are not benefiting from this trend and we need to target our efforts better if we want to end the TB epidemic,” said Andrea Ammon, MD, MPH, ECDC acting director.
Twice as many males as females were reported as having TB, and in the high-priority countries young adults from 25 to 44 had the highest rate. Of the estimated 323,000 European TB cases in 2015, 27,000 (8.4%) were co-infected with HIV. From 2011 to 2015, HIV, TB coinfection cases increased by 40%.
“One in three people co-infected with TB/HIV do not know about their status, which drastically lowers their chances of being cured,” Jakab continued. “In turn, this favors the spread of the diseases, putting health systems of governments under pressure.”
The analysis included countries both in and out of the European Union (EU)/European Economic Area (EEA). The report documented numbers on both overall TB cases per country, TB cases in people with known HIV status, and TB cases in people who were HIV-positive.
Out of the 28,957 TB cases in EU/EEA countries, 881 were in people with confirmed HIV (4.5%). Those with the highest HIV, TB coinfection rates were: Portugal (212 cases (14.3%)), Romania (274 cases (2.6%)), and Spain (154 cases (6.4%)). The researchers noted that not all countries were included because complete numbers weren’t provided.
Out of the 177,139 TB cases in non-EU/EEA countries, 115,499 were in people with confirmed HIV (9.5%). The countries with the highest HIV, TB coinfections were: Ukraine (6.637 cases (22.3%)), Russia (6,407 cases (9.8%)), and Uzbekistan (841 cases (6.4%)).
Only 337 out of 881 HIV-positive patients and 5,481 out of 15,499 HIV-positive patients started antiretroviral therapy (ART) in EU/EEA and non-EU/EEA countries, respectively.
Only 22 countries provided ART rates in HIV-positive people in 2015. Although numbers were better in 2014 than 2015, ART use was still significantly under the WHO target. In addition, EU/EEA countries were under the global target of 85% for successfully TB treatment in co-infected individuals.
“Although we know about the challenges of TB/HIV co-infection, for two out of three TB patients the essential information on their HIV status was not reported in 2015,” Ammon concluded. “We need to get better at this.”