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CDC calls for better screening efforts in US patients with HIV, TB
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Despite significant decreases in mortality among US patients with HIV and tuberculosis, nearly 25% of patients with tuberculosis still had unknown HIV status during 2006, according to new findings published in Morbidity and Mortality Weekly Report. CDC researchers are calling for an increase in testing, early treatment and increased preventive measures in this patient population.
“Persons with HIV are at increased risk for TB disease, and those with TB have a high risk for death,” the researchers wrote. “This is documented most clearly in resource-limited settings, where limited access to antiretroviral therapy and other health care services contribute to the elevated mortality. The impact … is less clear in resource-rich nations such as the US.”
Mortality from TB/HIV in US
To document the association between HIV and mortality in patients with TB in the US, Harold W. Jaffe, MD, associate director for science at the CDC, and colleagues pooled data on all US patients with TB between 1993 and 2008. Mortality was determined by HIV status.
Although mortality has significantly decreased in US patients with HIV and TB since 1993, approximately 25% of patients with TB still had unknown HIV status during 2006; and death occurred in 20% of patients with TB and HIV.
Moreover, in 2008, HIV status was unknown for 21% of patients despite 2006 guidelines that recommend all patients with TB in the US be tested for HIV.
Mortality in patients with TB and HIV decreased from 41% in 1993 to 20% in 2006, and the proportion of patients with HIV who died before TB diagnosis declined from 7% to 4%, respectively.
In an accompanying editorial, CDC officials wrote that, “This analysis demonstrates a substantial reduction in case-fatality rate among patients with TB in the US from 1993 to 2006, a decline that occurred almost exclusively in persons with HIV and correspond to an increase in reported HIV test results and broader availability of highly active ART.”
However, they added that the high proportion of unknown HIV status in patients with TB “is unacceptable given that knowledge of HIV status is essential for appropriate treatment and that current guidelines recommend HIV testing for all patients with TB in the US.”
Patients with HIV/TB in Kenya
In resource-limited settings, such as sub-Saharan Africa, the prevalence for HIV in patients with TB is estimated to be as high as 80% to 90%, according to data published in the same report.
Data were pooled on HIV cases from Kenya’s extended TB surveillance system between 2006 and 2009.
Results indicated that testing for HIV increased in patients with TB from 60% during 2006 to 88% during 2009. Moreover, cotrimoxazole prophylaxis was administered to 92% of this population during 2009. Yet, only 34% of patients with TB and HIV received antiretroviral therapy during treatment for TB.
“Efforts to reach HIV-infected TB patients through national TB programs can be successful but collaborative efforts must be strengthened to increase use of antiretroviral therapy among those patients,” the researchers wrote.
For more information:
- CDC. MMWR. 2010;59:1509-1517.