Overview of the HIV-Associated Tuberculosis Epidemic

Abstract

Globally, tuberculosis is the leading infectious cause of death and the most common opportunistic infection in people living with HIV (PLWH) (World Health Organization. Global Tuberculosis Report 2018). TB incidence has actually declined in the past 5 years both overall and for PLWH (World Health Organization. Global Tuberculosis Report 2018). However, efforts to achieve the target goals of the “End TB Strategy” both for people with and without HIV infection, will require more aggressive interventions aimed at each of the three pillars of TB control, including increased screening and diagnosis of TB infection and disease, rapid initiation of effective TB treatment, and more effective prevention of TB disease. The last decade has seen an explosion of new diagnostic technologies, development of new or novel antimycobacterial drugs, and the evolution of shorter course treatment for latent TB infection and drug resistant TB disease. While the next 5 years is likely to see a sea-change in our approaches to more effective treatment of TB, there are numerous barriers to the scale-up of new diagnostic tests and treatment regimens for PLWH that must be overcome to reach the rates of reduction in TB incidence that will be required to achieve the 2035 TB elimination goals.