Selected Media Coverage of the Report “HIV-TB Co

Transcription

Selected Media Coverage of the Report “HIV‐TB Co‐Infection: Meeting the Challenge” for the Forum for Collaborative HIV Research
November 2, 2007
TABLE OF CONTENTS
Angola
Wires………………………………………………………………………………………...………………7
Angola Press
Argentina
Wires……………………………………………………………………...…………………………………8
DERF—Agencia Federal de Noticias
Online……………………………………………………………………...………………………………...9
Bolson Web Noticias
Australia
Print……………………………………………………………………...…………………………………10
Pharmacy News
Online……………………………………………………………………...……………………………….11
ABC News
Austria
Online……………………………………………………………………...……………………………….12
Pressetext
Belgium
Online……………………………………………………………………………………………...............13
WebMember.be
Bulgaria
Online………………………………………………………………………………………………………15
Focus
Brazil
Print…………………………………………………………………………………………………………16
O Estado de S. Paolo
2 Canada
Print…………………………………………………………………………………………………………17
Vancouver Sun
Online………………………………………………………………………………………………………18
Radio-Canada.com
Cuba
Wires……………………………………………………………………………………………………….19
Prensa Latina
Denmark
Online………………………………………………………………………………………………………20
Kristeligt Dagblad Online
France
Wires………………………………………………………………………………………………………21
Agence France Presse
Agence France Presse-English
Reuters France
Print…………………………………………………………………………………………………………27

Centre Presse
Les Echos
Le Figaro
Le Monde
Online………………………………………………………………………………………………………32
Actualites News Environnement
International Herald Tribune Online
JeuneAfrique.com
Gabon
Online………………………………………………………………………………………………………38
Gabon Eco
Germany
Online………………………………………………………………………………………………………40
FAZ.Net
3 Iceland
Online………………………………………………………………………………………………………42
Mbl.is
India
Wires………………………………………………………………………………………………………43
IANS—Indo Asian News Service
Reuters India
Print…………………………………………………………………………………………………………46
Sunday Times of India
Online………………………………………………………………………………………………………47
CalcuttaNews,Net
Iran
Wires……………………………………………………………………………………………………….48
Alalam News Network
Italy
Wires……………………………………………………………………………………………………….49
APCOM News Agency
Malaysia
Online………………………………………………………………………………………………………50
Malaysia Sun Online
Morocco
Online………………………………………………………………………………………………………51
AtlasVista
Norway
Wires……………………………………………………………………………………………………….53
NTB—Norwegian News Agency
4 Portugal
Print………………………………………………………………………………………………………...54
Publico
Russia
Wires……………………………………………………………………………………………………….55
RIA Novosti
South Africa
Wires………….……………………………………………………………………..……………..………56
Health-e
Inter Press Service
Print………….……………………………………………………………………..……………..………..61
Cape Argus
Cape Times
Online………….……………………………………………………………………..……………..……..66
IOL.co.za – Independent Online
Mail & Guardian Online
Spain
Wires……………………………………………………………………………………………………….70
Europa Press
Taiwan
Online………………………………………………………………………………………………………71
China Post Online
Turkey
Online………………………………………………………………………………………………………73
TurkishPress.com
United Kingdom
Wires……………………………………………………………………………………………………….75
Reuters
Reuters AlertNet
5 Print…………………………………………………………………………………………………………79
Nature
New Scientist
The Times
Online…………………………………………………………………………………………..................82
BBC News
BBCMundo.com
NewScientist.com
United States
Wires………………………………………………………………………………………………………87

AHN—All Headline News
Associated Press
Dow Jones
UPI—United Press International
Print…………………………………………………………………………………………………………92

AIDS Weekly & Law
Los Angeles Times
Pharma Marketletter
Science
O nl in e……… ……… …… ……… …… ……… …… ……… …… ……… …… ……… …………99

AllAfrica.com
CBS News Online
Digital Journal
Forbes.com
FOXNews.com
GlobalHealthReporting.org
Houston Chronicle Online
KaiserNetwork.org (2)
MSNBC.com
Philadelphia Inquirer Online
WashingtonPost.com
Vietnam
Online……………………………………………………………………………………………………125
Tuoi Tre Online
6 ANGOLA
Wires
África: "Epidemia dupla" ameaça continente
Cidade do Cabo, 03/11 - Uma colisão de duas das mais mortíferas infecções do mundo, o HIV e a tuberculose,
criou uma nova co-epidemia letal, propagandando-se rapidamente pela África Sub-Sahariana.
Um novo relatório publicado sexta-feira aadverte que se os serviços de saúde do continente não se adaptarem
rapidamente, centenas de milhares de pessoas podem morrer de forma desnecessária.
Os serviços de saúde em África têm mais do que o suficiente com que se preocupar, os índices de infecção do
HIV são os mais elevados do mundo.
Mas agora a tuberculose está a reverter o pouco progresso que fizeram devido aos tratamentos anti-retrovirais.
De acordo com o relatório do Fórum de Investigação do HIV, uma colisão das duas epidemias está a afectar
algumas das comunidades mais pobres de África.
A Directora do Fórum, Veronica Miller, disse à BBC que a propagação da tuberculose tinha sido controlada
antes da chegada do HIV.
"Agora, especialmente na África sub-Sahariana, a tuberculose voltou a ficar fora do controlo e em conjunção
com a epidemia do HIV há uma convergência das duas doenças que se fomentam mutuamente."
A tuberculose não é pouco comum, cerca de 20% da população mundial é portadora do bacilo mas a maior
parte das pessoas nunca desenvolverá a doença.
Mas nos bairros pobres de África, onde as casas são superlotadas, a tuberculose é abundante.
O HIV destruiu os sistemas imunitários de pelo menos um quarto da população em algumas áreas.
Isto fez com que mais pessoas estejam não só a desenvolver a doença mas também a propagá-la a vizinhos
que, de outra forma, seriam saudáveis.
Numa comunidade a oeste da cidade sul-africana do Cabo, uma criança tem 100 vezes mais probabilidades de
contrair a tuberculose do que outra criança que viva no mundo desenvolvido.
Mas um dos investigadores na cidade do Cabo, o Dr. Stephen Lawn, afirma que muitas vezes os testes
existentes não conseguem detectar a tuberculose a tempo e os serviços de saúde não conseguem lidar com a
situação.
Sem o devido tratamento, 90% das pessoas com o HIV morrem meses depois de terem contraído a
tuberculose.
7 ARGENTINA
Wires
ENFERMEDADES
África: Una "Doble epidemia" amenaza
[02/11/2007 | 09:23 ] Un creciente número de infecciones simultáneas
con VIH y tuberculosis ha creado una co-epidemia que se extiende a
través del África subsahariana, indicaron investigadores.
Los sistemas locales de salud están siendo incapaces de contener la
co-epidemia, dijo el Foro para Investigación Cooperativa de VIH.
La situación se torna más urgente por las crecientes tasas de
tuberculosis resistente a los medicamentos en zonas con alta
prevalencia de VIH.
La mitad de todos los nuevos casos de tuberculosis en África
subsahariana presentan también co-infección con VIH, aseguró la
directora del foro, Verónica Miller.
Contagioso
En los barrios pobres de África, la tuberculosis es una enfermedad común, asevera el informe.
El VIH ha destruido los sistemas inmunes de al menos una cuarta parte de la población en algunas
zonas.
Debido a lo anterior, aumenta el número de personas que no solamente están desarrollando
tuberculosis, sino también contagiando a sus vecinos.
El corresponsal de la BBC en Ciudad del Cabo, Peter Greste, informa que zonas en esa ciudad
sudafricana están entre las más afectadas.
En una comunidad de la región de Ciudad del Cabo, un menor de edad tiene 100 veces más
probabilidad de contraer tuberculosis que la enfrentada por cualquier persona viviendo en el mundo
desarrollado.
Pero un investigador basado en Ciudad del Cabo, el doctor Stephen Lawn, asegura que los exámenes
médicos actualmente utilizados allí frecuentemente no consiguen identificar la tuberculosis antes de que
sea demasiado tarde.
Sin tratamiento adecuado, dice Lawn, 90% de las personas con VIH mueren pocos meses después de
contraer tuberculosis.
|| Fuente: 02 de noviembre de 2007 (BBC-ei)
http://www.derf.com.ar/despachos.asp?cod_des=166303&ID_Seccion=22
8 ARGENTINA
Online
Actualidad
03/11/2007 | "Doble epidemia" amenaza a África
Un creciente número de infecciones simultáneas con VIH y tuberculosis ha creado una co-epidemia
que se extiende a través del África subsahariana, indicaron investigadores.
Los sistemas locales de salud están siendo incapaces de contener la co-epidemia, dijo el Foro para
Investigación Cooperativa de VIH.
La situación se torna más urgente por las crecientes tasas de tuberculosis resistente a los
medicamentos en zonas con alta prevalencia de VIH.
La mitad de todos los nuevos casos de tuberculosis en África subsahariana presentan también coinfección con VIH, aseguró la directora del foro, Verónica Miller.
Contagioso
zonas.
El corresponsal de la BBC en Ciudad del Cabo, Peter Greste, informa que zonas en esa ciudad
desarrollado.
médicos actualmente utilizados allí frecuentemente no consiguen identificar la tuberculosis antes de
que sea demasiado tarde.
[BWN]
http://bolsonweb.com.ar/diariobolson/detalle.php?id_noticia=9333
9 AUSTRALIA
Print
Pharmacy News
November 22, 2007
SECTION: Pg. 12
LENGTH: 312 words
[… ]
HIV infants' vaccine risk
Vaccinating children against TB is supposed to save lives, not jeopardise them. Yet infants are at risk
from programs that fail to check their HIV status before giving them the BCG vaccine, says a report
published by the Washington DC-based Forum for Collaborative HIV Research.
Newborns are routinely given BCG in parts of the world where TB is rife, such as South Africa. But many
of those infants are born with HIV, and their weakened immune system makes them vulnerable to live
Mycobacterium bovis contained in the vaccine, which can itself cause a TB-like illness.
While it is important that TB vaccination continues, tests urgently need to be developed to screen babies
for HIV before vaccination, says Veronica Miller, who co-wrote the report.
Stories are from the 10 November issue of New Scientist magazine.
10 AUSTRALIA
Online
Researchers warn of co-epidemic in Africa
Posted Fri Nov 2, 2007 6:33pm AEDT
Researchers say HIV complicates even the most basic diagnosis. (File photo) (Reuters: Antony Njuguna)
Doctors and AIDS activists are warning that an increasing number of simultaneous tuberculosis (TB) and
HIV infections has created a deadly co-epidemic that is spreading throughout sub-Saharan Africa.
The Forum for Collaborative HIV Research says health systems in the region are unable to adequately
diagnose, treat or contain the co-epidemic.
Researcher involved in the report, Dr Stephen Lawn, says HIV complicates even the most basic
diagnosis.
"One of the problems with HIV is that it modifies how TB presents, so it changes the symptoms that
people typically get and also makes it more difficult to diagnose," Dr Lawn said.
- BBC
11 AUSTRIA
Online
HIV- und Tuberkulose-Epidemie bedroht Afrika
90 Prozent der Betroffenen sterben nach wenigen Monaten
Erkrankungsrisiko für Kinder 100 mal
höher als in anderen
Entwicklungsländern (Foto:
pixelio.de)
Kapstadt (pte/02.11.2007/10:00) - Eine steigende Anzahl von Doppelinfektionen mit HIV und Tuberkulose hat zu
einer epidemischen Ausbreitung der beiden Krankheiten in den afrikanischen Ländern südlich der Sahara geführt.
Laut dem Forum for Collaborative HIV Research http://www.hivforum.org ist die Gesundheitsversorgung nicht in
der Lage, die Epidemie einzudämmen. Weiter verschlimmert wird die Lage dadurch, dass die Resistenz gegen
Tuberkulose-Medikamente in Regionen mit einer hohen HIV-Infektionsrate immer weiter ansteigt. Veronica Miller,
Direktorin des Forums, berichtete, dass die Hälfte aller neuen Tuberkulose-Erkrankungen in dieser Region in
Kombination mit einer HIV-Infektion auftreten.
Tuberkulose ist nicht selten. Rund 20 Prozent der Weltbevölkerung ist betroffen. Häufig bricht die Krankheit laut
BBC jedoch nicht aus. In den afrikanischen Slums ist die Krankheit laut der Studie weit verbreitet. Da HIV in
manchen Regionen das Immunsystem von mindestens einem Viertel der Bevölkerung zerstört hat, erkranken viele
an Tuberkulose und stecken gleichzeitig ihre ansonsten gesunden Nachbarn an. Laut dem BBC-Journalisten Peter
Greste gehören die Bezirke rund um Kapstadt zu den am stärksten betroffenen.
In einer im Westen der Stadt gelegenen Gemeinde erkrankt ein Kind 100 Mal wahrscheinlicher an Tuberkulose als
jeder Mensch in den Entwicklungsländern. Der in Kapstadt arbeitende Wissenschaftler Stephen Lawn erklärte, dass
die vorhandenen Tests eine Erkrankung häufig erst zu spät erkennen und dass das Gesundheitswesen dem nichts
entgegensetzen kann. Ohne eine entsprechende Behandlung sterben 90 Prozent der Menschen mit HIV wenige
Monate nachdem sie sich mit Tuberkulose angesteckt haben. (Ende)
Aussender: pressetext.austria
Redakteur: Michaela Monschein
email: [email protected]
Tel. +43-1-81140-0
http://www.pressetext.at/pte.mc?pte=071102010
12 BELGIUM
Online
WebMember.be
AFP/DPA/Arch.-
La co-épidémie HIV/tuberculose se propage rapidement en Afrique
PARIS, 2 nov 2007 (AFP) 02/11/2007 17h39
La co-épidémie mortelle HIV/tuberculose se propage rapidement en Afrique sub-saharienne, rendant très difficile le
contrôle au niveau mondial de deux des maladies infectieuses les plus dangereuses, selon un rapport publié vendredi.
Près d'un tiers des 40 millions de personnes touchées par le VIH/sida dans le monde est également co-infecté par la
tuberculose (TB), et le taux de mortalité du VIH/TB est cinq fois supérieur à celui de la tuberculose seule, selon le rapport.
Le rapport publié par le Forum for Collaborative HIV Research (Washington - Etats-Unis), exhorte à entreprendre des
actions immédiates pour contrer la co-épidémie.
"L'oeil du cyclone se trouve actuellement en Afrique sub-saharienne où la moitié des nouveaux cas de TB est co-infectée
par le VIH, et où une TB résistante aux médicaments se propage insidieusement", déclare Veronica Miller, coauteur du
rapport et directrice du Forum, un partenariat public/privé international indépendant.
"Contrairement à la grippe aviaire, la menace VIH/TB au niveau mondial n'est nullement hypothétique. Elle existe, elle est
là", souligne-t-elle.
D'après le rapport, les cas de tuberculose multirésistante (MDR-TB - résistante à deux des principaux médicaments
prescrits contre la tuberculose) et de tuberculose ultrarésistante (XDR-TB - résistante à presque tous les médicaments de
première et deuxième lignes) sont en forte hausse et souvent accompagnés d'une co-infection par le VIH. On estime que
400.000 personnes sont actuellement infectées par la MDR-TB et 26.000 par la XDR-TB.
"Le taux de mortalité de la TB ultrarésistante combinée au VIH est effarant, avec plus de 80% des malades condamnés à
un décès rapide", indique Richard Chaisson, directeur de CREATE (Consortium to respond effectively to the AIDS-TB
Epidemic).
"Une nouvelle personne est infectée toutes les secondes" par la tuberculose, souligne Diane Havlir, présidente du Groupe
de travail TB/VIH (OMS). "Sachant qu'une grande partie de cette transmission se produit dans des régions avec une forte
prévalence du VIH, on comprend mieux le danger imminent de cette co-épidémie".
13 Un tiers de la population mondiale est infectée par la tuberculose, relève le rapport. Mais chez la majorité des personnes
infectées, la maladie restera à l'état latent. Le VIH modifie l'équation: chez les personnes dont le système immunitaire est
affaibli par le virus du sida, dix pour cent développeront chaque année une forme active de la TB.
Le rapport cite le cas d'une communauté de 13.000 personnes vivant à l'extérieur du Cap, en Afrique du Sud, où le
nombre de malades atteints de tuberculose a été multiplié par six entre 1996 et 2004. "Ce scénario s'est répété dans toute
l'Afrique australe", déclare Stephen Lawn, chercheur à l'Université du Cap.
Le rapport, qui se fonde sur les conclusions de travaux menés lors de la conférence de l'International Aids Society en
juillet à Sydney, appelle à des mesures urgentes parmi lesquelles: le développement de tests de diagnostic rapides de la
tuberculose résistante chez l'adulte et l'enfant VIH positifs ou l'utilisation de méthodes d'enquête sur la flambée
épidémique pour détecter rapidement les zones névralgiques de la TB résistante et du VIH.
http://www.webmember.be/news/fr/personnel/actu/g/actualite_agence_france_presse_afp.html/2007_11/
AFP/News_071102173932.mqysgb5z%7C36661847_18586929
14 BULGARIA
Online
World | World
Dual epidemic threatening Africa
3 November 2007 | 04:00 | FOCUS News Agency
A rising number of dual infections with HIV and tuberculosis has created a co-epidemic spreading throughout subSaharan Africa, researchers say, the BBC reports.
Local health systems are unable to contain the co-epidemic, the Forum for Collaborative HIV Research says.
The situation is made more urgent by increasing rates of drug-resistant TB in areas with a high prevalence of HIV.
Half of all new TB cases in sub-Saharan Africa are now HIV co-infected, forum director Veronica Miller said.
TB, which is a disease of the respiratory system, is not uncommon - about 20% of the world's population has it but
most will not develop the disease.
However in Africa's slums, where people live crammed together in tin shacks, TB is rife, the report notes.
Because HIV has destroyed the immune systems of at least a quarter of the population in some areas, far more
people are not only developing TB but spreading it to otherwise healthy neighbours.
The BBC's Peter Greste in Cape Town says areas around the South African city are among the worst affected.
In one community in the western Cape, a child is 100 times more likely to contract TB than anyone living in the
developed world.
But one Cape Town-based researcher, Dr Stephen Lawn, says existing tests often cannot spot TB before it is too late
and health care systems cannot cope.
Without proper treatment, the Forum for Collaborative HIV Research says, 90% of people with HIV die within
months of contracting TB.
http://www.focus-fen.net/index.php?id=n126055
15 BRAZIL
Print
16 CANADA
Print
17 CANADA
Online
Mise à jour le vendredi 2 novembre 2007 à 12 h 37
Quand le sida rencontre la tuberculose
Une coépidémie de VIH/sida et de tuberculose se propage rapidement dans les
pays d'Afrique subsaharienne, rapporte vendredi un organisme indépendant
constitué de chercheurs, de représentants gouvernementaux et de membres de
l'industrie pharmaceutique.
Le Forum for Collaborative HIV Research estime que la moitié des nouveaux cas
de tuberculose signalés dans cette région, l'une des plus pauvres du monde,
concernent des gens déjà infectés au VIH/sida. De nombreux enfants sont
touchés.
Photo: AFP/Trosten
Blackwood
La situation est d'autant plus grave que de plus en plus de gens contractent une
forme de tuberculose résistante aux médicaments, particulièrement dans les
endroits où le taux de prévalence du VIH/sida est déjà élevé.
Une victime de la coépidémie Au total, l'organisme estime qu'un tiers des 40 millions de personnes infectées au
en Papouasie-NouvelleVIH/sida dans le monde ont également la tuberculose. Le taux de mortalité de ces
Guinée.
malades est cinq fois plus élevé que celui recensé chez les gens qui n'ont que la
tuberculose.
« Contrairement à la grippe aviaire, la menace globale du VIH/sida-tuberculose n'est pas hypothétique. Elle est là
maintenant », plaide la directrice du Forum, Veronica Miller, qui soutient que les efforts de coordination déployés à ce
sujet sont tout à fait insuffisants.
Le rapport du Forum affirme que les efforts destinés à empêcher la propagation de la tuberculose ont été déstabilisés
par cette coépidémie dans les régions où le VIH/sida est répandu. Elle cite l'exemple d'une région d'Afrique du Sud,
près de la ville du Cap, où les cas de tuberculose se sont multipliés par six entre 1996 et 2004.
Or, selon le Forum, les systèmes de santé des pays aux prises avec cette coépidémie sont incapables de la
diagnostiquer, de la traiter ou de la contenir pour des raisons à la fois médicales et logistiques. Les malades
fréquentent par exemple des cliniques qui traitent l'une ou l'autre des maladies, et ces cliniques sont souvent
éloignées l'une de l'autre.
Qui plus est, le test utilisé le plus couramment en Afrique pour diagnostiquer la tuberculose est inefficace pour 40 %
à 80 % des gens déjà infectés par le VIH/sida. Un test plus efficace est inaccessible pour la grande majorité des
Africains. Ignorants de leur état de santé, des malades infectés par la tuberculose continuent de répandre la maladie.
L'établissement de cliniques offrant des services intégrés aux malades est donc nécessaire, estime le Forum.
Le fait que les gens étant coinfectés présentent des symptômes atypiques et que l'effet combiné des médicaments
utilisés pour soigner les deux maladies demeure méconnu ne fait qu'amplifier le problème.
Le Forum explique que l'endiguement de la coépidémie passe nécessairement par de nouvelles recherches
cliniques. Le développement de nouveaux tests de dépistage est notamment crucial et ces tests doivent être rendus
accessibles.
http://www.radio-canada.ca/nouvelles/International/2007/11/02/005-sida_tuberculose.shtml
18 CUBA
Wires
SIDA y tuberculosis atacan juntas a Africa subsahariana
Johannesburgo, 2 nov (PL) Una organización científica surafricana alertó hoy a la comunidad internacional de una
epidemia dual de SIDA y tuberculosis (TB) extendida sobre Africa subsahariana.
El Foro de Colaboración para la Investigación del Virus de Inmunodeficiencia Humana (HIV SIDA), apuntó que los
sistemas de salud de los países de esa zona carecen de los medios para detener a lo que llamaron co-epidemia.
La situación es urgente en áreas con un alto predominio del HIV, donde aumentó la presencia de un virus de
tuberculosis resistente a la mayoría de los tratamientos medicamentosos conocidos.
Según la directora de la mencionada entidad surafricana, Verónica Miller, la mitad de todos los casos actuales de la
TB se han registrado en Africa subsahariana asociados al SIDA.
Un niño residente en la localidad subsahariana de Cabo del Oeste es propenso 100 veces más a infectarse con
tuberculosis que una persona del mundo occidental, acotó Miller.
De acuerdo con la especialista, 20 de cada 100 personas en el planeta posee los gérmenes de la TB, aunque resulta
mínima la posibilidad de desarrollo de la enfermedad por la forma de alimentarse, de vivir y de diagnóstico
preventivo.
Sin embargo, en las condiciones del sur de este continente resulta bien diferente por la influencia de promiscuidades,
escasez de medicinas, médicos y educación.
rl arc
PL-11
19 DENMARK
Online
UDLAND
Dødelig dobbelt-epidemi truer Afrika
02. nov En foruroligende kombination af HIV og tuberkulose bliver stadig mere udbredt i flere
sydafrikanske lande
Et dødeligt makkerpar truer befolkningen i landene i det sydlige Afrika. Op mod halvdelen af alle nyligt HIV‐smittede syd for Sahara er nemlig også smittet med tuberkulose, viser ny forskning. Mange steder i de overbefolkede slumbebyggelser er en fjerdedel af beboerne smittet med HIV. Og med et nedbrudt immunforsvar er HIV‐patienterne potentielle smittebærere af tuberkulose, der nemt kan overføres til raske. Og med befolkningstætheden i de afrikanske byers slumområder er det meget vanskeligt at dæmme op for smittespredningen, skriver berlingske.dk. Situationen kompliceres yderligere af, at en resistent tuberkuloseart vinder frem og smitter flere og flere. Det gælder i slumområderne omkring den sydafrikanske by Cape Town, der er hovedcentret for den kombinerede HIV og tuberkulose‐epidemi. Tuberkulose er ofte en følgesygdom af HIV, der nedbryder kroppens naturlige immunforsvar, men tuberkulosen har hidtil kunnet bekæmpes med medicin, hvis den ellers er tilgængelig. Men behandlingskrævende tuberkulosepatienter lægger beslag på stadig større dele af de i forvejen knappe hospitalsressourcer i de fattige afrikanske lande. Og da frekvensen af tuberkulosesmittede i øjeblikket stiger dramatisk, er landenes lokale sundhedssystemer ude af stand til at dække behovet. Det amerikanske Forum for Collaborative HIV Research, der står bag undersøgelsen, advarer i en ny rapport om, at mindst 430.000 mennesker på verdensplan er smittet med resistente tuberkulose‐typer. Der er dog sandsynligvis et enormt mørketal i de afrikanske lande. http://www.kristeligt-dagblad.dk/artikel/265985:Udland--Doedelig-dobbelt-epidemi-truer-Afrika
20 FRANCE
Wires
Une modélisation du VIH, responsable du sida
2 nov. 07
PARIS, 2 nov 2007 (AFP) — La co-épidémie mortelle HIV/tuberculose se propage rapidement en Afrique
sub-saharienne, rendant très difficile le contrôle au niveau mondial de deux des maladies infectieuses les
plus dangereuses, selon un rapport publié vendredi.
Près d'un tiers des 40 millions de personnes touchées par le VIH/sida dans le monde est également coinfecté par la tuberculose (TB), et le taux de mortalité du VIH/TB est cinq fois supérieur à celui de la
tuberculose seule, selon le rapport.
Le rapport publié par le Forum for Collaborative HIV Research (Washington - Etats-Unis), exhorte à
entreprendre des actions immédiates pour contrer la co-épidémie.
"L'oeil du cyclone se trouve actuellement en Afrique sub-saharienne où la moitié des nouveaux cas de TB
est co-infectée par le VIH, et où une TB résistante aux médicaments se propage insidieusement", déclare
Veronica Miller, coauteur du rapport et directrice du Forum, un partenariat public/privé international
indépendant.
"Contrairement à la grippe aviaire, la menace VIH/TB au niveau mondial n'est nullement hypothétique.
Elle existe, elle est là", souligne-t-elle.
D'après le rapport, les cas de tuberculose multirésistante (MDR-TB - résistante à deux des principaux
médicaments prescrits contre la tuberculose) et de tuberculose ultrarésistante (XDR-TB - résistante à
presque tous les médicaments de première et deuxième lignes) sont en forte hausse et souvent
accompagnés d'une co-infection par le VIH. On estime que 400.000 personnes sont actuellement
infectées par la MDR-TB et 26.000 par la XDR-TB.
21 "Le taux de mortalité de la TB ultrarésistante combinée au VIH est effarant, avec plus de 80% des
malades condamnés à un décès rapide", indique Richard Chaisson, directeur de CREATE (Consortium to
respond effectively to the AIDS-TB Epidemic).
"Une nouvelle personne est infectée toutes les secondes" par la tuberculose, souligne Diane Havlir,
présidente du Groupe de travail TB/VIH (OMS). "Sachant qu'une grande partie de cette transmission se
produit dans des régions avec une forte prévalence du VIH, on comprend mieux le danger imminent de
cette co-épidémie".
Un tiers de la population mondiale est infectée par la tuberculose, relève le rapport. Mais chez la majorité
des personnes infectées, la maladie restera à l'état latent. Le VIH modifie l'équation: chez les personnes
dont le système immunitaire est affaibli par le virus du sida, dix pour cent développeront chaque année
une forme active de la TB.
Le rapport cite le cas d'une communauté de 13.000 personnes vivant à l'extérieur du Cap, en Afrique du
Sud, où le nombre de malades atteints de tuberculose a été multiplié par six entre 1996 et 2004. "Ce
scénario s'est répété dans toute l'Afrique australe", déclare Stephen Lawn, chercheur à l'Université du
Cap.
Le rapport, qui se fonde sur les conclusions de travaux menés lors de la conférence de l'International
Aids Society en juillet à Sydney, appelle à des mesures urgentes parmi lesquelles: le développement de
tests de diagnostic rapides de la tuberculose résistante chez l'adulte et l'enfant VIH positifs ou l'utilisation
de méthodes d'enquête sur la flambée épidémique pour détecter rapidement les zones névralgiques de la
TB résistante et du VIH.
22 Agence France Presse—English
Deadly HIV-TB co-epidemic sweeps sub-Saharan Africa: report
A HIV positive patient and her baby
Nov 2, 2007
PARIS (AFP) — Drug-resistant tuberculosis and HIV have merged into a double-barreled epidemic that is
sweeping across sub-Saharan Africa and threatening global efforts to eradicate both diseases, according
to a report released Friday.
Over-burdened health systems are unable to cope with the epidemic and risk collapse, said the report,
which calls for urgent measures to curb its spread.
A third of the world's 40 million HIV/AIDS sufferers also have TB, and the death rate for people infected
with both is five times higher than that for tuberculosis alone.
The situation is aggravated by surging rates of multi-drug resistant (MDR) and extensively drug-resistant
(XDR) TB precisely in those areas where the rates of HIV infection are highest.
MDR and XDR tuberculosis are resistant to some or all of the standard drugs used to fight the disease.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected," said
Veronica Miller, co-author of the report and director of The Forum for Collaborative HIV Research, which
issued the study.
"Unlike bird flu, the global threat of HIV/TB is not hypothetical -- it is here now," she said.
One third of the world's population carries the tuberculosis bacterium, but the disease remains latent in
nine out of 10.
HIV, however, changes the equation: Of those whose immune systems have been compromised by HIV,
10 percent will develop active tuberculosis each year, according to the report.
23 "In today's world, a new TB infection occurs every second. When one considers that much of this
transmission occurs in areas with high HIV prevalence, the imminent danger of a global co-epidemic is
clear," said Diane Havlir, head of the World Health Organisation's TB/HIV working group.
TB control has been severely destabilised in regions with high rates of HIV, the study says.
In one community of 13,000 people outside of Cape Town, South Africa, the TB patient case load
increased six-fold between 1996 and 2004, the researchers reported.
"There has been a staggering increase in TB in this community, and this has been replicated right across
southern Africa," Stephan Lawn, a medical researcher at the University of Cape Town, said in a
statement.
The report called for urgent coordinated action on the part of governments, researchers, drug companies
and local communities.
The measures called for include fast diagnostic tests to detect all forms of TB in HIV-infected adults and
children; new methods to rapidly map HIV and TB hotspots; new screening tools to identify new cases of
drug-resistant TB; and better equipment for field laboratories in the most affected areas.
There are approximately nine million new cases of tuberculosis in the world every year, according to the
WHO. In 2005, the disease killed 1.6 million people.
At the same time, an estimated 40 million people are living with HIV, according to the UN and the WHO.
There were 4.3 million new infections in 2006 with 2.8 million (65 percent) of these occurring in subSaharan Africa.
In 2006, 2.9 million people died of AIDS-related illnesses.
In South Africa, HIV/AIDS is the leading cause of child mortality and accounts for 40 to 60 percent of all
deaths nationwide, according to UNICEF.
http://afp.google.com/article/ALeqM5hm0OfScglB8CKBbSOBjkOxg3ojhA
24 Reuters France
Le BCG rendrait malades les enfants infectés par le VIH
sam. nov. 3, 2007 9:24 CST
par Maggie Fox
WASHINGTON (Reuters) - Un vaccin censé protéger les enfants de la tuberculose dans les pays en
voie de développement pourrait en fait en tuer ou du moins en affaiblir certains déjà infectés par le virus
du sida, ont affirmé vendredi des chercheurs.
Selon eux, le vaccin Bacille Calmette-Guérin ou BCG, fabriqué avec une version bovine de la
tuberculose, semble causer de graves infections chez certains bébés et enfants en bas âge infectés par
le VIH.
"Une étude a relevé un taux de mortalité de 75% chez des enfants souffrant du BCS, et 70% d'entre
eux étaient infectés par le VIH. C'est un problème qui, évidemment, mérite une attention immédiate",
explique le Dr Mark Cotton, pédiatre et chercheur spécialisé dans le VIH de l'université de Stellenbosch,
en Afrique du Sud.
Les résultats de Cotton sont cités dans un rapport publié vendredi sur l'urgence sanitaire que
représente, à l'échelle mondiale, la combinaison du VIH et de la tuberculose.
Le virus du sida détruit le système immunitaire et la tuberculose, qui avait reculé à l'échelle mondiale,
en a profité pour revenir en force. Une fois activée, la tuberculose, généralement une infection latente,
peut tuer rapidement.
"Maintenant, le secteur le plus touché est l'Afrique sub-saharienne, où la moitié des nouveaux cas de
tuberculose sont associés à une infection par le VIH, et où une tuberculose résistante aux traitements
est en train de s'étendre silencieusement", déplore Veronica Miller, directeur du Forum pour la
recherche collaborative sur le VIH.
COMBINAISON MORTELLE
Ce partenariat public-privé international et indépendant réunit des chercheurs, des défenseurs des
patients, ainsi que des représentants de gouvernements et de laboratoires.
"C'est déjà là, mais les ressources scientifiques et la coordination nécessaires pour l'arrêter sont très
insuffisants", souligne Miller.
25 Le virus de l'immunodéficience humaine touche environ 40 millions de personnes dans le monde entier.
On ne lui connaît pas de remède et quand il n'est pas soigné, il détruit progressivement le système
immunitaire, rendant les malades vulnérables face à toutes sortes d'autres infections, dont la
tuberculose.
La tuberculose touche un tiers de la population mondiale. Sans traitement approprié, 90% des
personnes infectées par le VIH et la tuberculose meurent en quelques mois.
Le BCG est administré à la naissance dans la plupart des pays en voie de développement, mais
comme il contient un bacille actif, il peut provoquer la maladie chez des personnes au système
immunitaire affaibli.
"C'est un problème notamment quand ils n'ont qu'un accès tardif au diagnostic de VIH ou à un
traitement antirétroviral", a expliqué Cotton dans une interview téléphonique.
"C'est aussi assez difficile à diagnostiquer", a-t-il ajouté. "Nous ne savons pas à quel point c'est
répandu en Afrique."
Une solution, selon lui, serait de vacciner les enfants au BCG une fois qu'on sait s'ils sont infectés par le
VIH.
Mais il serait encore préférable de diagnostiquer et de traiter plus tôt le VIH. Les enfants séropositifs
pourraient ainsi prendre un antibiotique, l'isoniazide, pour empêcher qu'ils n'attrapent la tuberculose,
estime Cotton.
26 FRANCE
Print
CENTRE PRESSE
3 novembre 2007 samedi
AFRIQUE Tuberculose et sida à l'attaque
LONGUEUR: 199 mots
La co-épidémie mortelle HIV/tuberculose se propage rapidement en Afrique sub-saharienne, rendant très
difficile le contrôle au niveau mondial de deux des maladies infectieuses les plus dangereuses, selon un
rapport. Près d'un tiers des 40 millions de personnes touchées par le VIH/sida dans le monde est
également co-infecté par la tuberculose (TB), et le taux de mortalité du VIH/TB est 5 fois supérieur à celui
de la tuberculose seule. « Contrairement à la grippe aviaire, la menace VIH/TB au niveau mondial n'est
nullement hypothétique », souligne Veronica Miller, coauteur du rapport. On estime que 400 000
personnes sont actuellement infectées par la tuberculose multirésistante et 26 000 par la variante
ultrarésistante de la maladie. « Le taux de mortalité de la TB ultrarésistante combinée au VIH est effarant,
avec plus de 80 % des malades condamnés à un décès rapide », indique Richard Chaisson, directeur de
CREATE (Consortium to respond effectively to the AIDS-TB Epidemic). « Une nouvelle personne est
infectée toutes les secondes » par la tuberculose, souligne Diane Havlir, présidente du Groupe de travail
sur le sujet à l'OMS. Une contamination toutes les secondes.AFP/R. Schmidt
27 28 29 La combinaison tuberculose-sida fait des ravages dans le monde
LE MONDE | 02.11.07 | 14h18 • Mis à jour le 02.11.07 | 14h18
Près d'un tiers des 40 millions de personnes infectées par le virus du sida (VIH) dans le monde le sont
également par le bacille de la tuberculose. Surtout présente en Afrique subsaharienne, où la moitié des
nouveaux cas de tuberculose survient chez des individus séropositifs pour le VIH, cette co-infection
entraîne une mortalité cinq fois supérieure à celle de la tuberculose seule. Rendu public vendredi 2
novembre, le rapport du Forum pour une recherche collaborative sur le VIH appelle à une action urgente
pour relever le défi que pose cette double épidémie.
Ce rapport est issu d'un symposium qui s'est tenu, en juillet, à Sydney (Australie), dans le cadre de la 4e
conférence de la Société internationale du sida. Le symposium avait notamment reçu, pour l'occasion, le
soutien de la Fondation Bill et Melinda Gates, de l'Agence nationale pour la recherche sur le sida et les
hépatites virales (ANRS, France) ou de laboratoires pharmaceutiques comme GlaxoSmithKline ou
Tibotec.
L'initiative est née de l'inquiétude suscitée par la disproportion entre l'ampleur du problème et le niveau
de ressources allouées à la recherche et aux programmes de lutte contre la tuberculose.
Malgré les efforts de l'Organisation mondiale de la santé (OMS), les progrès sont insuffisants. "Les
chercheurs sur le VIH n'ont pas considéré la tuberculose comme un problème nécessitant une attention
urgente, que cela soit dû à un intérêt limité ou à des priorités concurrentes, avec une division
traditionnelle entre les communautés VIH et tuberculose", constate le rapport. Celui-ci qualifie de
"désastreuses" les conséquences de cette situation dans les zones de forte prévalence de la co-infection
VIH et tuberculose.
"L'épidémie de sida a complètement déstabilisé le contrôle de la tuberculose dans les régions à forte
prévalence du VIH", note le document. La tuberculose est la maladie "opportuniste" qui se développe le
plus fréquemment chez les personnes infectées par le VIH.
"Chez les enfants et les adultes, la co-infection VIH-tuberculose demeure associée à une forte mortalité
inacceptable", indique le rapport. En 2005, sur 1,6 million de décès liés à la tuberculose dans le monde,
195 000 sont survenus chez des patients porteurs du VIH.
L'inquiétude est accrue par le développement de formes de tuberculose multirésistantes (à au moins
deux des principaux médicaments), voire ultrarésistantes, en particulier en Afrique du Sud, le pays
comptant le plus grand nombre de porteurs du VIH. Une étude sud-africaine a montré une multiplication
par six du nombre de cas de tuberculose.
Une épidémie de tuberculose ultrarésistante, en 2006, en Afrique du Sud, a "mis au jour des failles
significatives dans les programmes de contrôle de la tuberculose", souligne le rapport. En 2007, l'OMS
estime à 400 000 le nombre d'individus ayant une tuberculose multirésistante dans le monde, 28 000
développant une forme ultrarésistante.
MANQUE D'OUTILS MODERNES
"Globalement, les efforts de recherche actuellement consentis, aussi bien dans la population adulte
qu'infantile, sont complètement insuffisants face aux sérieux défis posés par l'épidémie de VIHtuberculose", jugent les auteurs du rapport. Ils pointent le fait que peu d'études ont été menées sur la
tuberculose chez l'enfant, bien que cette maladie soit souvent responsable d'une pneumonie aiguë en
30 cas de co-infection par le VIH. Pratiquée de manière courante, la vaccination par le BCG "est associée à
des risques sérieux chez les enfants infectés par le VIH", s'étonnent les auteurs.
Le document évoque aussi le manque d'outils modernes pour diagnostiquer la tuberculose, qualifiant les
tests actuels d'"antiques". Il plaide pour une meilleure surveillance épidémiologique de la tuberculose et
de ses formes résistantes, particulièrement en Afrique.
Tout en reconnaissant qu'il s'agit d'une question controversée, il met en avant les arguments en faveur du
traitement de prévention avec l'un des principaux antituberculeux, l'isoniazide. Selon le rapport, ce
médicament "peut réduire significativement l'incidence de la tuberculose chez les individus infectés par le
VIH".
Un atout d'autant plus intéressant que la stratégie prônée par l'OMS pour contrôler la tuberculose "doit
être étoffée, car elle échoue à diminuer l'incidence de la tuberculose dans les zones de forte prévalence
du VIH". Le Forum et les acteurs engagés dans la lutte contre la co-infection VIH-tuberculose entendent
poursuivre leurs efforts, à la fois sur le plan de l'information et de la science, pour combler le retard dans
ce domaine.
Paul Benkimoun
Article paru dans l'édition du 03.11.07
31 FRANCE
Online
SANTÉ - ALIMENTATION - RECHERCHE
Sida et tuberculose, une association meurtrière dans le
monde
02/11/2007 17:10 (Par Pierre MELQUIOT)
Sida et tuberculose, une association meurtrière dans le monde
Le virus VIH du sida et celui de la tuberculose, qui accélèrent mutuellement leur
progression, forment une association meurtrière dans le monde. Le virus VIH du sida
affaiblit le système immunitaire du malade, et donc une personne positive pour le VIH qui
est aussi infectée par le bacille a beaucoup plus de risques de contracter la tuberculose
qu’une personne infectée par le bacille mais qui est négative au virus VIH du sida.
Pour l’Organisation mondiale de la santé (OMS), la tuberculose est l’une cause majeure de
mortalité chez les VIH-positifs. La tuberculose est responsable de 13 % environ des décès
par sida dans le monde. En Afrique, le sida est le principal déterminant de la hausse de
l’incidence de la tuberculose observée ces dix dernières années.
L’OMS et ses partenaires internationaux ont formé le Groupe de travail tuberculose/VIH,
qui élabore une politique mondiale pour lutter contre la tuberculose liée au sida et
conseille sur la manière dont ceux qui combattent les deux maladies peuvent lutter
ensemble contre cette association meurtrière.
La politique provisoire sur les activités communes contre la tuberculose et le virus du sida
décrit les mesures à prendre pour établir des mécanismes de concertation entre les
programmes de lutte contre la tuberculose et contre le VIH/SIDA, pour réduire la charge
de la tuberculose chez les personnes vivant avec le VIH/SIDA et la charge de l’infection à
VIH chez les tuberculeux.
Dans cet esprit, la semaine prochaine se tiendra au Cap, en Afrique du Sud, une réunion
regroupant quelque 3.000 experts provenant d’une centaine de pays. Pendant cinq jours,
ces experts débattront de l’association meurtrière entre le virus de la tuberculose et celui
du VIH du sida.
Mais quand est-il ? On estime que plus de 1,6 million de personnes meurent de la
tuberculose tous les ans, et que près d'un tiers des 40 millions de malades infectées par le
virus du sida dans le monde le serait également par le bacille de la tuberculose.
32 En effet, selon un rapport du Forum pour une recherche collaborative sur le VIH rendu
public ce 2 novembre, cette double épidémie tuberculose / sida fait des ravages dans le
monde. Sur les 8,8 millions de malades atteints de la tuberculose, l'Organisation mondiale
de la santé (OMS) estime que 1,6 million d’entre eux décéderont dans l'année, et quelque
195 000 de ces personnes auraient une double infection avec le virus du sida.
Ce rapport est issu d'un symposium qui a eu lieu en juillet dernier à Sydney en Australie,
dans le cadre de la 4e conférence de la Société internationale du sida, avec le soutien de
la Fondation Bill et Melinda Gates, de l'Agence nationale pour la recherche sur le sida et les
hépatites virales (ANRS) et de laboratoires pharmaceutiques privés.
Pour l’OMS, l’objectif était d’accélérer la mise en place de moyens permettant de détecter
et de lutter contre la première cause d'infection chez les malades du sida sous traitement
antirétroviral.
http://www.actualites-news-environnement.com/12788-Sida-tuberculose-association-meurtriere.html
33 International Herald Tribune Online
Thousands Gather at TB Meet in S. Africa
By CLARE NULLIS
The Associated Press
CAPE TOWN, South Africa -- Old drugs. Outdated tests. Empty promises. New threats. Such is the bleak
reality surrounding an international tuberculosis conference opening Thursday in a city scarred by a killer
combination of TB and AIDS: an already nightmarish scenario worsened by the spread of untreatable
strains.
The 3,000 delegates will spend four days discussing the challenges posed by the dual epidemics of TB
and HIV _ which are still often treated separately although they feed off each other. About one-third of the
world's 40 million people infected with the AIDS virus have TB, the vast majority of them in Africa. TB kills
more than 1.6 million people every year.
"Unlike bird flu, the global threat of HIV/TB is not hypothetical. It is here now. But the science and
coordination needed to stop it are utterly insufficient," said Veronica Miller, director of The Forum for
Collaborative HIV Research, in a report released ahead of the Cape Town conference.
The only available vaccine was invented more than 85 years ago and fails to protect most people beyond
childhood. Antibiotics used to fight TB are more than 40 years old. Test methods used in most developing
countries were developed 120 years ago, are notoriously slow and often fail to spot TB in AIDS patients.
Health activists charge that rich countries and their pharmaceutical industries have shown little interest in
developing more effective drugs because TB primarily affects poor people in poor countries. There are
some new drug development and diagnostics initiatives but the activists say it's too little too late.
In a report issued Wednesday, the New York based advocacy Treatment Action Group accused the
United States and other donor nations of backsliding on commitments made last year to step up the fight
against TB.
It said that international spending for TB research and development remained stagnant at US$413 million
_ less than half the amount called for in a much-vaunted 2006 Global Plan to Stop TB to increase funding
for research on new TB diagnostics, drugs.
The contribution from the U.S. National Institutes of Health _ the biggest funder _ declined slightly to
US$120 million, it said. Mark Harrington, executive director of the Treatment Action Group, said that with
the U.S. budget problems and overspending in Iraq, TB wasn't "even on the radar" of the Bush
administration.
"Current funding levels for TB research and development are vastly out of proportion with the scope of the
TB epidemic," said Dr. Mario Raviglione, Director of the World Health Organization's Stop TB
Department.
34 The Treatment Action Group said the lack of funding was especially alarming given the global spread of
multidrug resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB), which was identified in 2006
and is now present in more than 40 countries.
The spread of the drug resistant forms of TB is largely the result of poorly managed TB care and patients
who don't take the full six-month course of treatment.
In South Africa, for instance, the cure rate for patients who stick to their treatment is just 50 percent, way
below WHO's target of 85 percent. In some areas, it is as low as 30 percent, according to Greg Hussey,
head of the University of Cape Town's Institute for Infectious Diseases. People who are not properly
cured are prone to develop MDR-TB which requires a two year treatment regimen.
South Africa hit the headlines last year when 53 people at a clinic in Tugela Ferry in KwaZulu-Natal were
diagnosed with HIV/XDR-TB. Nearly all of them died within two weeks because of their weakened
immune systems.
Because of the poor diagnostics, there are no reliable statistics on the number of South Africans who
have been infected with XDR-TB. The majority of them die before they can be tested or treated,
according to Gilles van Cutsem, a project coordinator for Medecins Sans Frontieres in the poor Cape
Town suburb of Khayelitsha, one of the hardest hit areas.
Little is known about the situation in neighboring countries like Swaziland and Mozambique, which also
have high HIV and TB rates but don't have proper laboratory facilities. But MSF and other organizations
say they fear the worst.
35 02/11/2007 17:39:55 - PARIS, 2 nov 2007 (AFP)
La co-épidémie HIV/tuberculose se propage rapidement en
Afrique
La co-épidémie mortelle HIV/tuberculose se propage rapidement en Afrique sub-saharienne, rendant
très difficile le contrôle au niveau mondial de deux des maladies infectieuses les plus dangereuses,
selon un rapport publié vendredi.
Près d'un tiers des 40 millions de personnes touchées par le VIH/sida dans le monde est également
co-infecté par la tuberculose (TB), et le taux de mortalité du VIH/TB est cinq fois supérieur à celui de
la tuberculose seule, selon le rapport.
Le rapport publié par le Forum for Collaborative HIV Research (Washington - Etats-Unis), exhorte à
entreprendre des actions immédiates pour contrer la co-épidémie.
"L'oeil du cyclone se trouve actuellement en Afrique sub-saharienne où la moitié des nouveaux cas de
TB est co-infectée par le VIH, et où une TB résistante aux médicaments se propage insidieusement",
déclare Veronica Miller, coauteur du rapport et directrice du Forum, un partenariat public/privé
international indépendant.
"Contrairement à la grippe aviaire, la menace VIH/TB au niveau mondial n'est nullement hypothétique.
Elle existe, elle est là", souligne-t-elle.
"Le taux de mortalité de la TB ultrarésistante combinée au VIH est effarant, avec plus de 80% des
malades condamnés à un décès rapide", indique Richard Chaisson, directeur de CREATE (Consortium
to respond effectively to the AIDS-TB Epidemic).
présidente du Groupe de travail TB/VIH (OMS). "Sachant qu'une grande partie de cette transmission
se produit dans des régions avec une forte prévalence du VIH, on comprend mieux le danger
imminent de cette co-épidémie".
Un tiers de la population mondiale est infectée par la tuberculose, relève le rapport. Mais chez la
majorité des personnes infectées, la maladie restera à l'état latent. Le VIH modifie l'équation: chez les
personnes dont le système immunitaire est affaibli par le virus du sida, dix pour cent développeront
chaque année une forme active de la TB.
36 Le rapport cite le cas d'une communauté de 13.000 personnes vivant à l'extérieur du Cap, en Afrique
du Sud, où le nombre de malades atteints de tuberculose a été multiplié par six entre 1996 et 2004.
"Ce scénario s'est répété dans toute l'Afrique australe", déclare Stephen Lawn, chercheur à l'Université
du Cap.
Aids Society en juillet à Sydney, appelle à des mesures urgentes parmi lesquelles: le développement
de tests de diagnostic rapides de la tuberculose résistante chez l'adulte et l'enfant VIH positifs ou
l'utilisation de méthodes d'enquête sur la flambée épidémique pour détecter rapidement les zones
névralgiques de la TB résistante et du VIH.
http://www.jeuneafrique.com/fluxafp/fil_info.asp?art_cle=40209
37 GABON
Online
La co-épidémie HIV/tuberculose se propage
rapidement en Afrique
La co-épidémie mortelle HIV/tuberculose se propage rapidement en Afrique sub-saharienne,
rendant très difficile le contrôle au niveau mondial de deux des maladies infectieuses les plus
dangereuses, selon un rapport publié vendredi.
Près d'un tiers des 40 millions de personnes touchées
par le VIH/sida dans le monde est également coinfecté par la tuberculose (TB), et le taux de mortalité
du VIH/TB est cinq fois supérieur à celui de la
tuberculose seule, selon le rapport.
Le rapport publié par le Forum for Collaborative HIV
Research (Washington - Etats-Unis), exhorte à
entreprendre des actions immédiates pour contrer la
co-épidémie.
"L'oeil du cyclone se trouve actuellement en Afrique
sub-saharienne où la moitié des nouveaux cas de TB
est co-infectée par le VIH, et où une TB résistante
aux médicaments se propage insidieusement",
déclare Veronica Miller, coauteur du rapport et
directrice du Forum, un partenariat public/privé
international indépendant.
"Contrairement à la grippe aviaire, la menace VIH/TB
au niveau mondial n'est nullement hypothétique. Elle
existe, elle est là", souligne-t-elle.
© AFP/DPA/Arch. : Une modélisation du
VIH, responsable du sida
malades condamnés à un décès rapide", indique Richard Chaisson, directeur de CREATE (Consortium
to respond effectively to the AIDS-TB Epidemic).
38 présidente du Groupe de travail TB/VIH (OMS). "Sachant qu'une grande partie de cette transmission
se produit dans des régions avec une forte prévalence du VIH, on comprend mieux le danger
imminent de cette co-épidémie".
majorité des personnes infectées, la maladie restera à l'état latent. Le VIH modifie l'équation: chez
les personnes dont le système immunitaire est affaibli par le virus du sida, dix pour cent
développeront chaque année une forme active de la TB.
Le rapport cite le cas d'une communauté de 13.000 personnes vivant à l'extérieur du Cap, en Afrique
du Sud, où le nombre de malades atteints de tuberculose a été multiplié par six entre 1996 et 2004.
"Ce scénario s'est répété dans toute l'Afrique australe", déclare Stephen Lawn, chercheur à
l'Université du Cap.
Aids Society en juillet à Sydney, appelle à des mesures urgentes parmi lesquelles: le développement
de tests de diagnostic rapides de la tuberculose résistante chez l'adulte et l'enfant VIH positifs ou
l'utilisation de méthodes d'enquête sur la flambée épidémique pour détecter rapidement les zones
névralgiques de la TB résistante et du VIH.
Publié le 03-11-2007
Source : AFP
http://www.gaboneco.com/show_article.php?IDActu=2724
39 Auteur : AFP
GERMANY
Online
AktuellGesellschaftGesundheit
Artikel-Services
HIV- und Tuberkulose-Epidemien
Doppelinfektion fordert immer mehr
Menschenleben
Von Reinhard Wandtner
Besonders in Afrika breitet sich die Doppelinfektion schnell aus
01. November 2007 Das seit mehreren Jahren zu beobachtende Zusammentreffen der globalen HIVund Tuberkulose-Epidemien fordert immer mehr Menschenleben. Vor allem in Afrika, südlich der
Sahara, breitet sich die Doppelinfektion rasend schnell aus.
Da Wissenschaft und Medizin noch vor vielen Fragen stehen, sind die Gesundheitssysteme nicht in der
Lage, diese Ko-Epidemie angemessen zu erkennen, zu behandeln oder einzudämmen. Das ergibt sich
aus einem Bericht, der an diesem Freitag vom „Forum for Collaborative HIV Research“ veröffentlicht
und von Experten weltweit führender Gesundheitsorganisationen gestützt wird.
Jede Sekunde kommt es zu einer neuen Infektion
Etwa zwei Milliarden Menschen, also rund ein Drittel der Weltbevölkerung, sind dem Bericht zufolge
mit dem Tuberkuloseerreger infiziert. Jede Sekunde komme es zu einer neuen Infektion. Bei intaktem
Immunsystem bricht die Krankheit in der Regel aber nicht aus. Durchschnittlich erkrankt nur jeder
zehnte Infizierte. Eine zusätzliche Infektion mit dem Immunschwächevirus HIV begünstigt den
Ausbruch der Tuberkulose indessen erheblich.
40 Zum Thema
•
Tuberkulose: Eine Geißel kehrt zurück
•
Gefährliche Tuberkulose auf dem Vormarsch
Bei Menschen, die beide Erreger in sich tragen, ist die Sterblichkeit fünfmal so hoch wie bei
Tuberkulose allein. Was das bedeutet, läßt sich angesichts der Tatsache erahnen, dass etwa ein Drittel
der weltweit 40 Millionen Menschen mit HIV-Infektionen und Aids gleichzeitig mit dem
Tuberkuloseerreger infiziert sind, wie es in dem Bericht heisst. In den Ländern südlich der Sahara liege
bei der Hälfte aller neuen Tuberkulosefälle eine zusätzliche Infektion mit HIV vor.
Tuberkuloseerreger zunehmend resistent
Drastisch erschwert wird der Kampf gegen die lebensbedrohlichen Doppelinfektionen dadurch, dass
immer mehr Tuberkuloseerreger auftauchen, die nicht mehr oder kaum noch auf Medikamente
ansprechen. Zusätzliche Schwierigkeiten bereiten Wechselwirkungen zwischen HIV- und
Tuberkulosemitteln. In dem jetzt vorgelegten Bericht werden daher rasche Verbesserungen bei der
Diagnose und Therapie angemahnt.
Text: FAZ.NET
Bildmaterial: REUTERS
41 ICELAND
Online
Mbl.is
Stuðningamenn landsliðs Suður-Afríku í rugby fagna liðinu í Pretoriu í morgun eftir frækilegan sigur þess á liði Englendinga. AP
Erlent | mbl.is | 2.11.2007 | 09:40 Faraldur HIV og berklasmits yfirvofandi í Afríku
Hætt er við því að faraldur samhliða smits HIV-veirunnar og berkla-bakteríunnar sé yfirvofandi í
Afríku sunnan Sahara, samkvæmt upplýsingum sérfræðinga samtakanna Forum for Collaborative
HIV Research. Segja þeir heilbrigðisyfirvöld í heimshlutanum ekki á nokkurn hátt í stakk búin til
að takast á við slíkan faraldur. Þetta kemur fram á fréttavef BBC.
Veronica Miller, formaður samtakanna, segir helming allra nýsmitaðra berklasjúklinga í
heimshlutanum nú vera HIV-smitaða og að það geri ástandið enn verra að berklabakteríur, sem
þróað hafa ónæmi gegn berklalyfjum, breiðist hratt út á þessum svæðum.
Berklabakterían er mjög útbreidd í heiminum og er talið að um 20% íbúar jarðar beri hana í sér.
Meirihluti þeirra sem bera bakteríuna í sér þróa þó að öllu jöfnu ekki með sér sjúkdóminn. Þar
sem HIV-smit veikir ónæmiskerfi líkamans er hins vegar hætta á því að HIV-smitaðir
einstaklingar veikist af berklum og að þeir beri smitið í aðra.
http://www.mbl.is/mm/frettir/erlent/frett.html?nid=1300446
42 INDIA
Wires
TOP STORIES
New danger in Africa: HIV-TB combined epidemic
By IANS
Friday November 2, 10:47 AM
Washington, Nov 2 (IANS) A deadly combination of HIV and tuberculosis (TB) is rapidly spreading in subSaharan Africa and has gone largely unnoticed so far.
Health systems, moreover, are not adequately equipped to diagnose, treat or contain the co-epidemic due to
unanswered scientific and medical questions, according to a report issued Thursday by The Forum for
Collaborative HIV Research here.
The report notes that approximately one-third of the world's 40 million people with HIV/AIDS are also
infected with TB and the mortality rate due to the co-epidemic is five-fold higher than that for tuberculosis
alone.
'The eye of the storm is in sub-Saharan Africa, where half of all new TB cases are HIV co-infected, and
where drug-resistant TB is silently spreading,' said Veronica Miller, one of the authors of the report.
'Unlike bird flu, the global threat of HIV-TB is not hypothetical. It is here now. But the science and
coordination needed to stop it are utterly insufficient,' she said.
The HIV-TB co-infection was first detected 23 years ago. Without proper treatment, 90 percent of people
living with HIV die within months of contracting TB.
43 Reuters India
TB vaccine sickens HIV-infected children: report
Sat Nov 3, 2007 2:14am IST
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - A vaccine aimed at protecting children in developing countries from deadly
tuberculosis may be killing and sickening some vulnerable infants infected with the AIDS virus,
researchers said on Friday.
They said the Bacille Calmette-Guerin or BCG vaccine, which is made using a bovine version of
tuberculosis, appeared to be causing serious infections in some babies and young children who are HIVinfected.
"One study found a 75-percent mortality rate in children with BCG disease, and 70 percent of those
children were HIV-infected. Clearly, this is a problem in need of immediate attention," said Dr. Mark
Cotton, a pediatrician and HIV researcher at Stellenbosch University in South Africa.
Cotton's findings are part of a report issued on Friday about the health emergency caused globally by the
double whammy of HIV and TB.
The AIDS virus destroys the immune system, and tuberculosis has made a return globally because of
this. Usually a latent infection, activated TB can kill quickly.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected, and
where drug-resistant TB is silently spreading," said Veronica Miller, director of The Forum for
Collaborative HIV Research, a global independent public-private group that includes researchers, patient
advocates, and government and industry.
"It is here now. But the science and coordination needed to stop it are utterly insufficient."
The human immunodeficiency virus infects an estimated 40 million people globally. There is no cure and
when untreated, it steadily destroys the immune system. Patients are vulnerable to a range of infections
including TB.
BILLIONS INFECTED
TB infects one-third of the world's population. Without proper treatment, 90 percent of people infected
with both die within months.
Usually, tuberculosis only becomes an active infection in one out of 10 people over a lifetime. But 10
percent of HIV patients who also have TB develop activated tuberculosis every year.
The BCG vaccine is given at birth in most developing countries. But because it uses a live microbe, in
people with weakened immune systems it can itself cause disease.
44 "It is especially a problem where they have delayed access to diagnosis of HIV or delayed access to
antiretroviral therapy," Cotton said in a telephone interview.
"It also is quite hard to diagnose it," he added. "We don't know how widespread it is across Africa."
Cotton said an estimated 400 per 100,000 HIV-infected infants in the Western Cape of South Africa had
become sick from the BCG vaccine.
"The problem is the vaccine is usually given within the first few days of life," Cotton said. But babies are
not tested for HIV infection until about 6 weeks of age, meaning many infants are unknowingly being
given a vaccine that is dangerous for them.
Cotton said it might be possible to simply vaccinate children with BCG after it is known whether they are
HIV-infected.
"But once you interfere with a program and make it a bit complicated, it can have repercussions as well,
so it is a bit of a dilemma," he said.
The best result would be to have earlier diagnosis and treatment of HIV. Children infected with HIV can
be given an antibiotic, isoniazid, to prevent TB infection, Cotton said.
http://in.reuters.com/article/health/idINN0264899620071102
45 INDIA
Print
November 4, 2007 46 INDIA
Online
TB and HIV link-up in African epidemic
Calcutta News.Net
Friday 2nd November, 2007
Dual infections of HIV and tuberculosis are being created throughout sub-Saharan Africa,
causing an epidemic.
Called a co-epidemic, local health systems are insisting the situation has been made more
urgent because TB is becoming drug resistant in high-prevalence HIV areas.
About 20% of the world's population has TB, although the disease lies dormant in most of
those people.
However in Africa's slums, where people are confined to crammed-in shacks, TB is rife
because HIV has already ravaged the immune systems of TB carriers.
Without proper treatment, 90% of people with HIV die within months of contracting TB.
http://www.calcuttanews.net/story/296338
47 IRAN
Wires
Africa Faces AIDS, TB Co-Epidemic
LONDON, Nov 3--A rising number of dual
infections with HIV and tuberculosis has
created a co-epidemic spreading throughout
sub-Saharan Africa, researchers say.
Local health systems are unable to contain the coepidemic, the Forum for Collaborative HIV
Research says.
The situation is made more urgent by increasing
rates of drug-resistant TB in areas with a high prevalence of HIV.
Half of all new TB cases in sub-Saharan Africa are now HIV co-infected, forum director
Veronica Miller said.
TB, which is a disease of the respiratory system, is not uncommon - about 20% of the
world's population has it but most will not develop the disease.
However in Africa's slums, where people live crammed together in tin shacks, TB is rife, the
report notes.
Because HIV has destroyed the immune systems of at least a quarter of the population in
some areas, far more people are not only developing TB but spreading it to otherwise
healthy neighbors.
The BBC's Peter Greste in Cape Town says areas around the South African city are among
the worst affected.
In one community in the western Cape, a child is 100 times more likely to contract TB than
anyone living in the developed world.
But one Cape Town-based researcher, Dr Stephen Lawn, says existing tests often cannot
spot TB before it is too late and health care systems cannot cope.
Without proper treatment, the Forum for Collaborative HIV Research says, 90% of people
with HIV die within months of contracting TB.
http://www.alalam.ir/english/en-NewsPage.asp?newsid=020090120071103214159 48 ITALY
Wires
APCOM News Agency
IN AUMENTO CASI DI DOPPIA INFEZIONE DA HIV E TUBERCOLOSI
Ricercatori Usa: i servizi sanitari locali sono insufficienti
postato 1 ora fa da APCOM
Roma, 2 nov. (Apcom) - Il crescente numero di pazienti colpiti da doppia infezione di Hiv e tubercolosi ha
determinato la diffusione nell'Africa sub-sahariana di una coepidemia che i sistemi sanitari locali non sono
in grado di fronteggiare.
Stando a quanto denunciato dal 'Forum for Collaborative Hiv Research' negli Usa e riportato oggi dalla
Bbc, la situazione è resa più drammatica dal crescente tasso di resistenza ai medicinali contro la
tubercolosi nelle aree dove sono più numerosi i casi di Hiv. Metà dei nuovi casi di malati da tubercolosi
sono oggi affetti anche da Hiv, ha precisato la direttrice del Forum, Veronica Miller. L'Hiv distrugge infatti
il sistema immunitario delle persone colpite, favorendo la diffusione della tubercolosi.
49 MALAYSIA
Online
TB and HIV link-up in African epidemic
Malaysia Sun
Friday 2nd November, 2007
Dual infections of HIV and tuberculosis are being created throughout sub-Saharan
Africa, causing an epidemic.
Called a co-epidemic, local health systems are insisting the situation has been made
more urgent because TB is becoming drug resistant in high-prevalence HIV areas.
About 20% of the world's population has TB, although the disease lies dormant in most
of those people.
However in Africa's slums, where people are confined to crammed-in shacks, TB is rife
because HIV has already ravaged the immune systems of TB carriers.
Without proper treatment, 90% of people with HIV die within months of contracting TB.
50 MOROCCO
Online
PARIS, 2 nov 2007 (AFP) - La co-épidémie mortelle HIV/tuberculose se propage rapidement en
Afrique sub-saharienne, rendant très difficile le contrôle au niveau mondial de deux des maladies
infectieuses les plus dangereuses, selon un rapport publié vendredi.
Près d'un tiers des 40 millions de personnes touchées par le VIH/sida dans le monde est
également co-infecté par la tuberculose (TB), et le taux de mortalité du VIH/TB est cinq fois
supérieur à celui de la tuberculose seule, selon le rapport.
Le rapport publié par le Forum for Collaborative HIV Research (Washington - Etats-Unis), exhorte
à entreprendre des actions immédiates pour contrer la co-épidémie.
"L'oeil du cyclone se trouve actuellement en Afrique sub-saharienne où la moitié des nouveaux
cas de TB est co-infectée par le VIH, et où une TB résistante aux médicaments se propage
insidieusement", déclare Veronica Miller, coauteur du rapport et directrice du Forum, un
partenariat public/privé international indépendant.
"Contrairement à la grippe aviaire, la menace VIH/TB au niveau mondial n'est nullement
hypothétique. Elle existe, elle est là", souligne-t-elle.
D'après le rapport, les cas de tuberculose multirésistante (MDR-TB - résistante à deux des
principaux médicaments prescrits contre la tuberculose) et de tuberculose ultrarésistante (XDRTB - résistante à presque tous les médicaments de première et deuxième lignes) sont en forte
hausse et souvent accompagnés d'une co-infection par le VIH. On estime que 400.000 personnes
sont actuellement infectées par la MDR-TB et 26.000 par la XDR-TB.
malades condamnés à un décès rapide", indique Richard Chaisson, directeur de CREATE
(Consortium to respond effectively to the AIDS-TB Epidemic).
"Une nouvelle personne est infectée toutes les secondes" par la tuberculose, souligne Diane
Havlir, présidente du Groupe de travail TB/VIH (OMS). "Sachant qu'une grande partie de cette
transmission se produit dans des régions avec une forte prévalence du VIH, on comprend mieux
le danger imminent de cette co-épidémie".
majorité des personnes infectées, la maladie restera à l'état latent. Le VIH modifie l'équation:
chez les personnes dont le système immunitaire est affaibli par le virus du sida, dix pour cent
développeront chaque année une forme active de la TB.
Le rapport cite le cas d'une communauté de 13.000 personnes vivant à l'extérieur du Cap, en
Afrique du Sud, où le nombre de malades atteints de tuberculose a été multiplié par six entre
1996 et 2004. "Ce scénario s'est répété dans toute l'Afrique australe", déclare Stephen Lawn,
chercheur à l'Université du Cap.
51 Le rapport, qui se fonde sur les conclusions de travaux menés lors de la conférence de
l'International Aids Society en juillet à Sydney, appelle à des mesures urgentes parmi lesquelles:
le développement de tests de diagnostic rapides de la tuberculose résistante chez l'adulte et
l'enfant VIH positifs ou l'utilisation de méthodes d'enquête sur la flambée épidémique pour
détecter rapidement les zones névralgiques de la TB résistante et du VIH.
Publié le: 02/11/2007 à 17:39:53 GMT
Source : AFP
http://www.avmaroc.com/actualite/epidemie-hiv-a107115.html
52 NORWAY
Wires
NTB-Norwegian News Agency
Dobbeltepidemi i Afrika
02.nov 2007 13:04
Stadig flere afrikanere blir smittet av både hiv og tuberkulose. En farlig dobbeltepidemi sprer seg
dermed gjennom Afrika, og lokale helsetjenester står maktesløse overfor trusselen, sier forskere.
Situasjonen er spesielt alvorlig fordi varianter av tuberkulose som er resistente - motstandsdyktige - mot
vanlige medisiner, sprer seg i områder med mange hivtilfeller. Dobbeltsmitten er spesielt utbredt i
slumområder, meldte BBC fredag.
- Halvparten av alle de nylig tuberkulosesmittede pasientene i Afrika sør for Sahara, er nå også
hivsmittet, sier Veronica Miller ifølge den britiske rikskringkastingens nettsider. Miller leder organisasjonen
Forum for samarbeidende hivforskning.
HIV ødelegger immunforsvaret
Tuberkulosesmitte er svært vanlig, i den forstand at rundt 20 prosent av verdens befolkning er bærere av
smitten, selv om de fleste aldri vil utvikle sykdommen. Men i de tettpakkede afrikanske slummene er
forholdene annerledes.
Her har nemlig hivviruset ødelagt immunforsvaret hos svært mange mennesker, i enkelte områder rundt
en firedel av befolkningen. Dermed utvikler flere enn normalt tuberkulose, og mange av dem smitter også
sine naboer. (NTB)
53 PORTUGAL
Print
54 RUSSIA
Wires
RIA Novosti
Últimas noticias
SIDA y tuberculosis atacan juntas a Africa subsahariana
11:04 | 02/ 11/ 2007
Johannesburgo, 2 de noviembre, PL, para RIA Novosti. Una organización científica surafricana alertó hoy a la
comunidad internacional de una epidemia dual de SIDA y tuberculosis (TB) extendida sobre Africa subsahariana.
El Foro de Colaboración para la Investigación del Virus de Inmunodeficiencia Humana (HIV SIDA), apuntó que los
sistemas de salud de los países de esa zona carecen de los medios para detener a lo que llamaron co-epidemia.
La situación es urgente en áreas con un alto predominio del HIV, donde aumentó la presencia de un virus de
tuberculosis resistente a la mayoría de los tratamientos medicamentosos conocidos.
Según la directora de la mencionada entidad surafricana, Verónica Miller, la mitad de todos los casos actuales de la
TB se han registrado en Africa subsahariana asociados al SIDA.
Un niño residente en la localidad subsahariana de Cabo del Oeste es propenso 100 veces más a infectarse con
tuberculosis que una persona del mundo occidental, acotó Miller.
De acuerdo con la especialista, 20 de cada 100 personas en el planeta posee los gérmenes de la TB, aunque resulta
mínima la posibilidad de desarrollo de la enfermedad por la forma de alimentarse, de vivir y de diagnóstico
preventivo.
Sin embargo, en las condiciones del sur de este continente resulta bien diferente por la influencia de promiscuidades,
escasez de medicinas, médicos y educación.
55 SOUTH AFRICA
Wires
Not enough research to treat TB-HIV properly, say experts
Anso Thom
02.11.2007
Health systems cannot properly diagnose, treat, or contain the co-epidemic of HIV and tuberculosis (TB) because
not enough is known about how the two diseases interact.
A report by leading global health experts warned that the largely “unnoticed collision” of the global
epidemics of HIV and TB has exploded to create a deadly co-epidemic that is rapidly spreading in subSaharan Africa.
Approximately one-third of the world’s 40 million people with HIV/AIDS are co-infected with TB, and the
mortality rate for HIV-TB co-infection is five-fold higher than that for tuberculosis alone.
This situation is made yet more urgent by the surging rates of multi-drug resistant (MDR) TB in some
areas with high HIV prevalence, according to the report compiled by the Forum for Collaborative HIV
Research, a global independent partnership comprised of researchers, patient advocates, government
and industry representatives.
“The eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected, and
where drug-resistant TB is silently spreading,” said Veronica Miller, co-author of the report and director of
the Forum.
“Unlike bird flu, the global threat of HIV/TB is not hypothetical. It is here now. But the science and
coordination needed to stop it are utterly insufficient.”
The report details several of the most urgent problems in need of accelerated research:
Diagnosis of HIV-TB
In many clinics, HIV can be reliably diagnosed in as little as 15 minutes using a simple test. In contrast,
the standard diagnostic test for TB, invented 120 years ago, fails to detect between 40 percent to 80
percent of TB cases in those with HIV-TB. While a more advanced sputum culture test exists, a lack of
laboratory facilities means the test is unavailable for the overwhelming majority of patients in Africa. Even
when it is available, results typically take many weeks to obtain. During that time, people with active TB,
including MDR- and XDR-TB, may unknowingly spread their infection.
56 Detection of TB is further complicated by atypical symptoms in people who are co-infected. In coinfection, TB is less likely to cause typical lung disease and more likely to cause “disseminated TB,”
affecting almost any organ of the body. This makes standard chest x-rays much less useful for diagnosis.
TB in HIV-Infected Children
Almost one-quarter of HIV-infected children develop TB every year and drug-resistant TB among children
is increasing. Many unanswered questions remain in the diagnosis and treatment of pediatric HIV-TB coinfection, and there is a lack of pediatric drug formulations for both TB and HIV drugs. Despite all this,
very few clinical trials of childhood TB have been conducted to optimize diagnosis or treatment outcomes.
“Nearly every infant with HIV suffers from pneumonia. TB also causes acute pneumonia, but with our
current tools it is hard to know what is and is not caused by TB,” said Mark Cotton, a pediatrician and HIV
researcher at Stellenbosch University. “Children should be included in trials to evaluate new anti-TB
drugs.”
A further cause for concern is the use of the Bacille Calmette-Guérin (BCG) vaccine in children, the report
says. The vaccine provides some protection against disseminated TB in children. Therefore, based on
WHO recommendations, BCG is given once at birth in most developing countries. But recent studies
have found high rates of BCG disease and related deaths in HIV-infected infants who have received the
vaccine, and WHO has issued an advisory note regarding the use of BCG in HIV-infected children.
“One study found a 75 percent mortality rate in children with BCG disease, and 70 percent of those
children were HIV-infected. Clearly, this is a problem in need of immediate attention,” Cotton said.
Infection Control
A medicine that appears to prevent active disease in HIV/TB co-infected patients, thus aiding infection
control, is practically unused for this purpose, says the report. The medicine, Isoniazid, is a front-line
drug used to treat TB. But concerns about Isoniazid Preventive Therapy (IPT) are such that Botswana is
the only country in sub-Saharan Africa to use IPT nationally. These concerns include the potential for
IPT-related drug resistance, the short duration of IPT efficacy, and the difficulties in ruling out active TB in
co-infected people.
“Research that definitively addresses these concerns is needed now, in order to make this tool available
or come up with alternatives to control the spread of infection,” Stephen Lawn, a medical researcher at
the University of Cape Town, said.
First detected 23 years ago, HIV-TB now affects nearly one-third of the 40 million people infected with
HIV. Without proper treatment, 90 percent of people living with HIV die within months of contracting TB.
“In today’s world, a new TB infection occurs every second. When one considers that much of this
clear,” said Diane Havlir, Chair of the WHO TB/HIV Working Group.
According to the report, the HIV epidemic has completely destabilized TB control in regions with high
rates of HIV.
For example, in one community (not identified in the report) of 13 000 people outside of Cape Town, the
TB patient caseload increased six-fold between 1996 and 2004, from 30 to 180 patients per year. Rates
of TB in this community are over 150-fold higher than the national rates in many high-income countries.
“There has been a staggering increase in TB in this community, and this has been replicated right across
southern Africa,” said Lawn.
The report also cites the outbreak of HIV and extensively drug resistant (XDR) TB in Tugela Ferry,
KwaZulu-Natal, where the number of cases has increased five-fold in the last two years. All of the 53
people originally diagnosed with XDR TB in this outbreak were co-infected with HIV.
57 They suffered an extremely high mortality rate of 98 percent, and survived only an average of 16 days
from the time of diagnosis. Since then, over 450 cases of MDR -TB have been reported in Tugela Ferry,
of which 55 percent are XDR-TB cases, most co-infected with HIV.
The mortality rate for XDR TB has dropped slightly, but is still high at approximately 85 percent, and even
mortality rates among MDR TB cases in this setting remain alarmingly high, approaching 70 percent.
Tugela Ferry is not alone. Global estimates of multi-drug resistant TB are skyrocketing. As of October
2007, XDR TB had been confirmed in 41 countries, up from 17 countries in March 2006. There are now
an estimated 400 000 individuals infected with MDR TB and 26 000 infected with XDR-TB. But experts
warn that these numbers underestimate the problem, since there is no data from many high HIV
prevalence areas.
“The mortality rate from extensively drug-resistant TB in combination with HIV is staggering, with more
than 80 percent of patients dying rapidly,” said Richard Chaisson, Director of CREATE (Consortium to
Respond Effective to the AIDS TB Epidemic).
“Despite the urgency and severity of the problem, we have neither the drug testing nor the surveillance
tools in place to know the full extent of XDR-TB and HIV across large areas of Africa.” South Africa is the
only country in sub-Saharan Africa with the laboratory capacity to diagnose XDR-TB. – Health-e News
Service.
BOX
Key research questions and other measures needed to stem the HIV-TB co-epidemic:
• Research to develop safe rapid diagnostic tests to detect both drug-susceptible and drugresistant TB, for use in HIV-infected adults and children at the point of care.
• Development of screening tools to identify potential cases of MDR/XDR-TB.
• Equipping laboratories to be able to diagnose MDR and XDR-TB.
• Use of outbreak investigative methods to rapidly map out hotspots of HIV and drug-resistant TB,
rather than relying upon standard surveillance methods.
• Research addressing practical questions, such as ventilation, that can facilitate implementation of
infection control procedures in health care facilities
• Research into diagnostic tools to exclude active TB before initiation of Isoniazid Preventive
Therapy (IPT) in HIV-infected patients, in order to avoid under treating active TB, which could
lead to drug resistance.
• Authoritative studies to determine the risk of IPT causing isoniazid resistance.
• Research to better understand TB and HIV drug interactions in adults and children and to
optimize treatment in both groups.
• Studies on the virological, immunological, and microbiological outcomes of HIV-TB co-infection in
children.
• Evaluation of BCG vaccination in HIV-infected children.
• Research to provide evidence-based models for HIV-TB programs at local, district, and national
levels, in rural areas and cities, to demonstrate ways in which HIV and TB programs can
positively interact and deliver services.
• Resources, advocacy, and community mobilization to push for implementation and to prioritize
the HIV/TB research agenda.
http://www.health-e.org.za/news/article.php?uid=20031801
58 Inter Press Service
November 2, 2007 Friday
HIV AND TB - AN EVER DEADLIER COMBINATION
BYLINE: Miriam Mannak
LENGTH: 977 words
The prevalence of tuberculosis (TB) amongst people living with HIV in sub-Saharan Africa has reached
crisis levels and will escalate further if decisive steps are not taken, says a new report by the Forum for
Collaborative HIV Research -- 'HIV-TB Co-Infection: Meeting the Challenge'.
The forum is a public-private initiative based in Washington.
With more than 60 percent of HIV positive people living in sub-Saharan Africa, the region has proved
fertile ground for TB: the compromised immune systems of AIDS patients are often unable to combat the
disease.
In addition, failing health systems and insufficient knowledge, research, data collection and funding are
encouraging the spread of HIV-TB across sub-Saharan Africa and the rest of the world, notes the study -released Friday. Half of new TB cases now occur amongst people in sub-Saharan Africa who have
contracted the AIDS virus, while a third of the world's 40 million HIV positive people are infected with TB.
"The global threat of the HIV-TB co-epidemic is not hypothetical. It is here now; yet the science and coordination that are needed to stop this are utterly insufficient," said Veronica Miller, co-author of the report
and director of the Forum for Collaborative HIV Research.
"HIV and TB programmes and research funding have run through completely different funding and
administrative streams. Because of this, opportunities for taking both diseases into account, instead of
tackling either one of them, have been missed."
Miller told IPS that funding for new drugs and diagnostics to treat TB is very limited, "This despite these
new tools (being) urgently needed, considering the effects that HIV has on the TB disease course and
vice versa."
"Action is needed now, especially for sub-Saharan Africa, where not only half of new cases are HIV coinfected -- but where drug-resistant TB is in the rise," said Miller.
TB is an airborne disease which mostly affects the lungs and is transmitted through coughing -- also a
symptom of the illness -- and sneezing, spitting or speaking.
In instances where the disease has reached an advanced stage, patients may cough up blood. Other
symptoms of this highly contagious and potentially deadly condition include loss of weight and appetite,
fatigue, and the development of a fever.
Tuberculosis bacteria can remain dormant in a patient, who is then unable to pass on the disease. TB
becomes reactivated if a person's immune system is compromised, as occurs with HIV infection.
"People who are HIV negative and have dormant TB have a 10 percent (chance) of developing active TB
during their lifetime," said Stephen Lawn, a medical researcher at the University of Cape Town in South
Africa. "When HIV is in an advanced stage, this can be as high as 30 percent."
59 Lawn has done extensive work on HIV-TB, and is active in townships -- mainly poor areas set aside for
blacks under apartheid -- where the rates of HIV-TB are among the highest in the world.
Those HIV positive persons who do develop TB face slim chances of survival: 90 percent of people living
with HIV/AIDS die within months of contracting the disease. "Their immune systems are too weak to fight
both HIV and TB," Lawn explained.
TB can usually be cured with a six-month course of antibiotics to which patients must rigorously adhere.
Treatment can also be used to prevent the dormant bacteria from becoming active.
"We need to take into account both diseases (HIV and TB) at every single opportunity. Every time
someone is tested for one, they should be tested for the other," said Miller.
Diagnosing TB in HIV patients can prove difficult, however.
One method of detecting the illness involves injecting a protein from TB bacteria into the skin of the arm.
If this causes swelling, it may be a sign that the person has dormant or active TB.
But, because people with HIV have a weaker immune system, this swelling does not always appear. As a
result, "These people will receive their treatment too late, which increases their chances of developing
active TB and infecting others," Lawn told IPS.
"On average, someone who suffers from HIV-TB infects 20 to 30 people in the course of his or her
illness."
In its recommendations for addressing the co-epidemic, 'HIV-TB Co-Infection: Meeting the Challenge'
calls for more funds to research TB and HIV drug interactions in adults and children. Additionally, new
studies should be done on HIV-TB co-infection in children. In South Africa, for instance, almost 25
percent of HIV-infected children contract TB annually.
Improvements to treatment are also required. Health care workers, especially in Africa, are ill-equipped to
deal with the challenges posed by HIV-TB, a situation worsened by the emergence of TB drug resistance.
In recent years, multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB)
have been reported, notably in Southern Africa. MDR-TB is resistant to the top two TB drugs, and XDRTB to the vast majority of first- and second-line drugs.
Miller noted that better laboratory infrastructure should be put in place for drug sensitivity testing, amongst
others.
According to Lawn, health care systems should also monitor their patients more closely. "Many people
infected with TB quit their treatment when they feel better, or refuse treatment altogether because they do
not feel sick."
The report also addresses the role anti-retroviral drugs (ARVs) could play in tackling the HIV-TB coepidemic. ARVs are used to prolong the lives of AIDS patients.
"As ARVs boost one's immune system, they could possibly help to prevent dormant TB from becoming
active," Lawn noted.
"It is definitely not the magic bullet, and at this stage we do not know what the magic bullet is. Therefore
we need help from all directions, and lots of it, to find a solution to the problem."
Distributed by AllAfrica Global Media. (allafrica.com)
60 SOUTH AFRICA
Print
HIV-TB combo to shake Cape townships
2 November 2007
By Di Caelers
The twin storms of HIV and tuberculosis are colliding, with Western Cape townships at the epicentre,
notching up TB rates 150 times higher than the national rates in many high-income countries.
HIV-TB, deadlier and more difficult to diagnose and treat than either disease alone, has taken hold here,
with some areas recording up to an eight-fold spiral in their TB caseload since 1996.
The Western Cape is in the spotlight in a new report released on Friday, HIV-TB Co-infection: Meeting
the Challenge, which reflects an unprecedented consensus among leading global health organisations on
the need for action before the co-epidemic spreads globally.
The call is echoed by local specialists who warn that laboratory facilities here are being swamped with
demand for testing, while health staff are demoralised and struggling to cope.
'That level of
problem is
occurring in many
other townships of
Cape Town'
The report details a study of an unnamed local township, with a population of about
13 000 people, where the TB clinic had seen a six-fold increase in TB patient
caseload between 1996 and 2004.
The rise in TB incidence mirrored that of HIV prevalence, which climbed from 6
percent to 22 percent during the same period.
On Friday, according to research specialist Dr Stephen Lawn, that increase was more than eight-fold and
he stressed that the situation was not unique to that single township.
"That level of problem is occurring in many other townships of Cape Town where we are seeing disease
levels of that magnitude," said Lawn, a clinician scientist at UCT's Desmond Tutu HIV Centre.
First detected 23 years ago, HIV-TB now affects nearly one-third of the 40-million people infected with
HIV worldwide.
Without proper treatment, 90 percent of people living with HIV die within months of
'Now the eye of the
contracting TB.
storm is in subSaharan Africa,
The report said the situation was made even more urgent by the surging rates of
where half of new
multi-drug resistant TB in some areas with high HIV prevalence.
TB cases are HIV
co-infected'
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases
are HIV co-infected, and where drug-resistant TB is silently spreading," said Veronica Miller, co-author of
61 the report and director of the Forum for Collaborative HIV Research.
Unlike bird flu, the global threat of HIV-TB was not hypothetical.
"It is here now. But the science and co-ordination needed to stop it are utterly insufficient," she said.
Lawn said that in South Africa generally, and in the Western Cape specifically, health authorities had a
responsibility to provide the necessary resources to treat patients.
"Clinics are understaffed to deal with the huge numbers of people attending and it's becoming more and
more difficult to make sure patients complete their full course of treatment.
"Manpower, facilities and administration resources haven't kept pace with the growth in patient numbers,"
he said. This was also demoralising for staff who were "working their socks off" while the epidemic
continued growing.
On testing, the report authors warned that the standard diagnostic test for TB, invented 120 years ago,
failed to detect between 40 percent and 80 percent of TB cases in those with HIV-TB.
A more advanced test does exist and Lawn said that while the new tests were not an option for most of
Africa, "for SA they are".
"But ... there is a serious need for greater resources to support the laboratories in the diagnosis of TB," he
said.
Lawn said of the Western Cape that "when you have TB rates in your communities that are the highest in
the world, it really should take very high priority in terms of the politicians and health spend"
62 November 08, 2007 Thursday
e1 Edition
We cannot foreclose on the promise of a better life for all
BYLINE: Mamphela Ramphele
SECTION: NEWS; Pg. 9
LENGTH: 1330 words
This week, government leaders, scientists and healthcare workers, representatives from patient groups,
and thousands of others are in South Africa for the 38th Union World Conference on Lung Health - the
world's most important meeting on tuberculosis (TB).
This is the first time in the conference's history that it is being held in the developing world. We are glad to
welcome the world's leading experts on TB to our country and to southern Africa.
Southern Africa is ground zero for TB. Our region includes nine out of the 15 countries in the world with
the highest estimated TB incidence rates; moreover, five of the world's 22 high burden TB nations are in
the region, according to the World Health Organisation (WHO).
Unfortunately, the trends offer little hope of reversal. Southern Africa is nowhere near meeting the STOP
TB Partnership target of halving the 1990 prevalence and death rates by 2015. Instead, most indicators
show that movement is only one way: in the wrong direction.
The devastating HIV epidemic in southern Africa has received widespread global attention in recent
years. By comparison, the equally extensive TB epidemic in the region is practically hidden. That is a
grave and deadly mistake. The two diseases are closely linked and require greater co-ordinated
responses.
Two facts point to the urgency: TB is by far the greatest killer of people living with HIV in the region, and
the average HIV prevalence in new TB cases is greater than 50%. In general, if untreated, TB in people
living with HIV leads to death in weeks.
South Africa's own TB epidemic has exploded since the arrival of the Aids epidemic. In 2005, the most
recent year for which we have available data, 337 309 new cases were reported, which was a rise of 8%
over the previous year. Our success rate in treating what is a curable disease is only 57.7%, far from the
WHO's goal of 85%.
Sadly, these numbers mask even greater problems in treating TB in South Africa. Cure rates are as low
as 12% in the Nkangala district in Mpumalanga, 18% in KwaZulu-Natal's Uthungulu district and 20% in
the Northern Cape's Frances Baard district.
63 What can we do to respond to the twin epidemics of TB and HIV in southern Africa? There have been
many reports and recommendations on these issues, but what practical steps can we take immediately to
make things better?
First, we need to get more people living with HIV tested for TB.
Some 750 000 people living with HIV will develop TB this year, mostly in sub-Saharan Africa. Although
TB is curable, around the world approximately 200 people living with HIV die each day of TB.
TB remains the leading cause of death in people living with HIV in southern Africa, despite increased
access to anti-retroviral therapy.
Among the myriad reasons is that many people present to health services late. The mortality from TB,
even in those started on treatment, is high.
What do we need to do? We need to find more cases of active TB and treat them earlier. People living
with HIV must know if they have TB.
However, the fear of contracting TB has made the disease and those who have it highly stigmatised,
often driving people away from seeking services, including testing. The best way to fight the stigma
associated with TB is to educate communities about the disease and to shatter the myths about what is
largely a preventable and curable illness.
Second, TB and HIV services remain largely separate in many countries. Individuals affected by both
diseases often have to attend different clinics on different days for each disease, and these may well be
geographically distant from each other. Opportunities are being missed to provide comprehensive and
integrated care as close to the patient as possible. Far too many people are slipping through the cracks.
What can we do now? There are simple things that can be done, such as harmonising HIV and TB patient
registers so we can see if people are getting the requisite care for both TB and HIV. HIV and TB
programmes need to be co-ordinated, and our leaders must hold their managers accountable for bringing
these two services together in one place.
Third, we need to strengthen healthcare systems to ensure that they are adequate to the task of dealing
holistically with the increasing challenges that we face.
This will enable us to co-ordinate HIV and TB programmes.
We need to deal with infection control. All over southern Africa, people living with HIV are sharing clinic
and hospital waiting rooms and wards with undiagnosed TB patients. The risk of TB transmission in
healthcare settings for people living with HIV, as well as healthcare workers and support staff, is
extremely high. Yet, despite such risks, basic infection-control procedures are not implemented in most
facilities.
All those working in health facilities, including doctors, nurses, administrators, clerks and cleaners, need
to be trained in infection-control procedures, on the occupational risk of TB, and on how to protect
themselves from exposure.
Simple measures, such as cough hygiene (covering one's mouth when coughing) and opening windows
to provide adequate ventilation, can be instituted easily in high-risk settings.
Finally, the recent reports of the emergence of extreme drug-resistant TB (XDR-TB) in South Africa
indicate that the TB situation in southern Africa is potentially even more ominous, especially for people
living with HIV.
64 XDR-TB is essentially untreatable and a death sentence for people living with HIV.
It is unlikely that the emergence of XDR-TB in South Africa is a limited "outbreak"; instead, it is most
probably a sustained epidemic resulting from inadequate TB control in the region.
We need to improve our TB and HIV services to successfully tackle multi-drug resistant (MDR-TB) and
XDR-TB in our region. Intemperate responses, such as calls to forcibly quarantine MDR and XDR
patients without regard for their basic human rights, will not succeed.
Instead, we need to improve adherence to treatment and TB cure rates by supporting community
education and patients' treatment literacy on TB; to ensure patients with MDR- and XDR-TB get
immediate access to anti-retroviral therapy; to invest in new models of treating MDR-TB that don't rely on
isolation in the few overcrowded and under-staffed special wards that are available; and to keep people
from getting infected with TB by promoting infection control in healthcare facilities and wherever people
gather in close quarters, whether in taxis, churches, shebeens, government offices or at home.
Outside South Africa, the true extent of drug-resistant TB throughout the region is not yet known. Most
countries in our region do not have the ability to diagnose MDR- or XDR-TB due to the lack of availability,
complexity and cost of specialised tests for these strains of TB.
MDR-TB can be treated - although the course of treatment is longer and the second-line drugs are less
effective, more costly and have greater side effects than the treatment for regular TB.
Unfortunately, treatment for MDR-TB is unavailable except in South Africa and in far smaller pilot sites in
Lesotho. Elsewhere in the region, people with MDR-TB are mostly undiagnosed and, ultimately, are left to
die. This is unacceptable, and governments throughout the region need to work with donors such as the
Global Fund to Fight Aids, TB and Malaria to expand access to MDR/XDR testing and treatment, while
ensuring these drugs are used properly as they are our last defence against this deadly scourge.
As the world comes to Cape Town this week to discuss TB, we here in southern Africa have a lot of work
to do once the conference is over.
There is no time to lose. HIV and TB cannot be allowed to foreclose on the promise of a better life for our
people that we fought so hard for. We have faced harder, more intractable struggles and overcome the
odds - we can do the same against these two killer diseases in our midst.
Dr Ramphele is the former vice-chancellor of the University of Cape Town.
65 SOUTH AFRICA
Online
HIV-TB combo to shake Cape townships
Di Caelers
November 02 2007 at 02:47PM
The twin storms of HIV and tuberculosis are colliding, with Western Cape townships at the epicentre, notching up TB
rates 150 times higher than the national rates in many high-income countries.
HIV-TB, deadlier and more difficult to diagnose and treat than either disease alone, has taken hold here, with some
areas recording up to an eight-fold spiral in their TB caseload since 1996.
The Western Cape is in the spotlight in a new report released on Friday, HIV-TB Co-infection: Meeting the Challenge,
which reflects an unprecedented consensus among leading global health organisations on the need for action before
the co-epidemic spreads globally.
The call is echoed by local specialists who warn that laboratory facilities here are being swamped with demand for
testing, while health staff are demoralised and struggling to cope.
'That level of
problem is
occurring in
many other
townships of
Cape Town'
The report details a study of an unnamed local township, with a population of about 13 000
people, where the TB clinic had seen a six-fold increase in TB patient caseload between
1996 and 2004.
The rise in TB incidence mirrored that of HIV prevalence, which climbed from 6 percent to
22 percent during the same period.
On Friday, according to research specialist Dr Stephen Lawn, that increase was more than
eight-fold and he stressed that the situation was not unique to that single township.
"That level of problem is occurring in many other townships of Cape Town where we are seeing disease levels of that
magnitude," said Lawn, a clinician scientist at UCT's Desmond Tutu HIV Centre.
First detected 23 years ago, HIV-TB now affects nearly one-third of the 40-million people infected with HIV worldwide.
'ow the eye of
the storm is in
sub-Saharan
Africa, where
half of new TB
cases are HIV
co-infected'
Without proper treatment, 90 percent of people living with HIV die within months of
contracting TB.
The report said the situation was made even more urgent by the surging rates of multi-drug
resistant TB in some areas with high HIV prevalence.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV coinfected, and where drug-resistant TB is silently spreading," said Veronica Miller, co-author
of the report and director of the Forum for Collaborative HIV Research.
Unlike bird flu, the global threat of HIV-TB was not hypothetical.
66 "It is here now. But the science and co-ordination needed to stop it are utterly insufficient," she said.
Lawn said that in South Africa generally, and in the Western Cape specifically, health authorities had a responsibility
to provide the necessary resources to treat patients.
"Clinics are understaffed to deal with the huge numbers of people attending and it's becoming more and more difficult
to make sure patients complete their full course of treatment.
"Manpower, facilities and administration resources haven't kept pace with the growth in patient numbers," he said.
This was also demoralising for staff who were "working their socks off" while the epidemic continued growing.
On testing, the report authors warned that the standard diagnostic test for TB, invented 120 years ago, failed to
detect between 40 percent and 80 percent of TB cases in those with HIV-TB.
A more advanced test does exist and Lawn said that while the new tests were not an option for most of Africa, "for SA
they are".
"But ... there is a serious need for greater resources to support the laboratories in the diagnosis of TB," he said.
Lawn said of the Western Cape that "when you have TB rates in your communities that are the highest in the world, it
really should take very high priority in terms of the politicians and health spend".
http://www.int.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20071102112808263C975039
67 AFRICA
Deadly TB, HIV merge into co-epidemic
Paris, France
02 November 2007 03:25
Drug-resistant tuberculosis (TB) and HIV have merged into a double-barrelled pandemic that is sweeping
across sub-Saharan Africa and threatening global efforts to eradicate both diseases, according to a report
released on Friday.
Overburdened health systems are unable to cope with the pandemic and risk collapse, says the report,
which calls for urgent measures to curb its spread.
One-third of the world's 40-million people living with HIV/Aids also have TB, and the death rate for people
infected with both is five times higher than that for TB alone.
The situation is aggravated by surging rates of multidrug-resistant (MDR) and extensively drug-resistant
(XDR) TB precisely in those areas where the rates of HIV infection are highest.
MDR-TB and XDR-TB are resistant to some or all of the standard drugs used to fight the disease.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected,"
says Veronica Miller, co-author of the report and director of the Forum for Collaborative HIV Research,
which issued the study.
One-third of the world's population carries the TB bacterium, but the disease remains latent in nine out of
10. HIV, however, changes the equation: of those whose immune systems have been compromised by
HIV, 10% will develop active TB each year, according to the report.
"In today's world, a new TB infection occurs every second. When one considers that much of this
clear," says Diane Havlir, head of the World Health Organisation's (WHO) working group on TB/HIV.
In one community of 13 000 people outside Cape Town, South Africa, the TB patient case load increased
six-fold between 1996 and 2004, the researchers report.
Southern Africa," Stephan Lawn, a medical researcher at the University of Cape Town, said in a
statement.
The report calls for urgent coordinated action on the part of governments, researchers, drug companies
and local communities.
The measures called for include fast diagnostic tests to detect all forms of TB in HIV-infected adults and
68 children; new methods to map HIV and TB hot spots rapidly; new screening tools to identify new cases of
drug-resistant TB; and better equipment for field laboratories in the most affected areas.
There are approximately nine million new cases of TB in the world every year, according to the WHO. In
2005, the disease killed 1,6-million people.
At the same time, an estimated 40-million people are living with HIV, according to the United Nations and
WHO. There were 4,3-million new infections in 2006 with 2,8-million (65%) of these occurring in subSaharan Africa.
In 2006, 2,9-million people died of Aids-related illnesses.
In South Africa, HIV/Aids is the leading cause of child mortality and accounts for 40% to 60% of all deaths
nationwide, according to the UN Children's Fund. -- AFP
69 SPAIN
Wires
Internacional
África.-La doble infección de VIH y tuberculosis se
convierte en epidemia en toda el África subsahariana,
según expertos
LONDRES, 2 Nov. (EUROPA PRESS) La doble infección del virus del VIH y de tuberculosis se ha convertido en epidemia debido al gran incremento de
los casos conocidos en toda el África subsahariana, y las administraciones locales de salud son incapaces de
contenerla, según anunció hoy el Forum sobre la Investigación del VIH.
La situación se ha hecho todavía más urgente por el aumento de los casos de resistencia a los medicamentos
contra la tuberculosis en zonas donde hay gran presencia del VIH, indica la cadena de televisión británica BBC.
La directora del Forum, Veronica Miller, alertó de que todos los nuevos casos de tuberculosis en el África
subsahariana son ahora dobles infecciones junto con VIH.
La tuberculosis es padecida por aproximadamente un 20 por ciento de la población mundial, pero en la mayoría de
las ocasiones la enfermedad no se llega a desarrollar. Sin embargo, en los barrios de África, donde la gente vive
hacinada en pequeñas chabolas, la tuberculosis abunda.
Según el informe del Forum de Investigación, debido a que el VIH ha destruido los sistemas de inmunidad de al
menos un cuarto de la población de estas zonas africanas, cada vez más gente no sólo desarrolla tuberculosis sino
que la expande por los barrios vecinos.
El corresponsal de la BBC en Sudáfrica asegura que alrededor de Ciudad del Cabo hay zonas que se sitúan entre
las más afectadas. En un vecindario en el oeste de la ciudad, un niño está 100 veces más expuesto a padecer
tuberculosis que otro que viva en el mundo desarrollado.
Uno de los investigadores del Forum en Ciudad del Cabo, el doctor Stephen Lawn, señala que existen pruebas
que normalmente no identifican la tuberculosis antes de que sea demasiado tarde y que las autoridades no pueden
hacer mucho. Sin un tratamiento adecuado, el 90 por ciento de la población con VIH muere en los meses siguientes
tras contagiarse de tuberculosis, asegura Lawn, citado por la BBC.
70 TAIWAN
Online
HEALTH
TB vaccine sickens kids infected with HIV: report
Sunday, November 4, 2007
Reuters
WASHINGTON -- A vaccine aimed at protecting children in developing countries from deadly tuberculosis may be
killing and sickening some vulnerable infants infected with the AIDS virus, researchers said on Friday.
They said the Bacille Calmette-Guerin or BCG vaccine, which is made using a bovine version of tuberculosis,
appeared to be causing serious infections in some babies and young children who are HIV-infected. "One study
found a 75-percent mortality rate in children with BCG disease, and 70 percent of those children were HIV-infected.
Clearly, this is a problem in need of immediate attention," said Dr. Mark Cotton, a pediatrician and HIV researcher
at Stellenbosch University in South Africa.
Cotton's findings are part of a report issued on Friday about the health emergency caused globally by the double
whammy of HIV and TB.
The AIDS virus destroys the immune system, and tuberculosis has made a return globally because of this. Usually a
latent infection, activated TB can kill quickly.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected, and where
drug-resistant TB is silently spreading," said Veronica Miller, director of The Forum for Collaborative HIV
Research, a global independent public-private group that includes researchers, patient advocates, and government
and industry. "It is here now. But the science and coordination needed to stop it are utterly insufficient."
The human immunodeficiency virus infects an estimated 40 million people globally. There is no cure and when
untreated, it steadily destroys the immune system. Patients are vulnerable to a range of infections including TB.
TB infects one-third of the world's population. Without proper treatment, 90 percent of people infected with both die
within months.
71 Usually, tuberculosis only becomes an active infection in one out of 10 people over a lifetime. But 10 percent of
HIV patients who also have TB develop activated tuberculosis every year.
The BCG vaccine is given at birth in most developing countries. But because it uses a live microbe, in people with
weakened immune systems it can itself cause disease.
"It is especially a problem where they have delayed access to diagnosis of HIV or delayed access to antiretroviral
therapy," Cotton said in a telephone interview.
Cotton said an estimated 400 per 100,000 HIV-infected infants in the Western Cape of South Africa had become
sick from the BCG vaccine.
http://www.chinapost.com.tw/health/2007/11/04/129440/TB-vaccine.htm
72 TURKEY
Online
Deadly HIV-TB co-epidemic sweeps sub-Saharan Africa: report
Published: 11/2/2007
PARIS - Drug-resistant tuberculosis and HIV have merged into a double-barreled epidemic that is sweeping across
sub-Saharan Africa and threatening global efforts to eradicate both diseases, according to a report released Friday.
Over-burdened health systems are unable to cope with the epidemic and risk collapse, said the report, which calls for
urgent measures to curb its spread.
A third of the world's 40 million HIV/AIDS sufferers also have TB, and the death rate for people infected with both is
five times higher than that for tuberculosis alone.
The situation is aggravated by surging rates of multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB
precisely in those areas where the rates of HIV infection are highest.
MDR and XDR tuberculosis are resistant to some or all of the standard drugs used to fight the disease.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected," said Veronica
Miller, co-author of the report and director of The Forum for Collaborative HIV Research, which issued the study.
One third of the world's population carries the tuberculosis bacterium, but the disease remains latent in nine out of 10.
HIV, however, changes the equation: Of those whose immune systems have been compromised by HIV, 10 percent
will develop active tuberculosis each year, according to the report.
"In today's world, a new TB infection occurs every second. When one considers that much of this transmission occurs
in areas with high HIV prevalence, the imminent danger of a global co-epidemic is clear," said Diane Havlir, head of
the World Health Organisation's TB/HIV working group.
In one community of 13,000 people outside of Cape Town, South Africa, the TB patient case load increased six-fold
between 1996 and 2004, the researchers reported.
"There has been a staggering increase in TB in this community, and this has been replicated right across southern
Africa," Stephan Lawn, a medical researcher at the University of Cape Town, said in a statement.
The report called for urgent coordinated action on the part of governments, researchers, drug companies and local
communities.
The measures called for include fast diagnostic tests to detect all forms of TB in HIV-infected adults and children; new
methods to rapidly map HIV and TB hotspots; new screening tools to identify new cases of drug-resistant TB; and
better equipment for field laboratories in the most affected areas.
73 There are approximately nine million new cases of tuberculosis in the world every year, according to the WHO. In
2005, the disease killed 1.6 million people.
At the same time, an estimated 40 million people are living with HIV, according to the UN and the WHO. There were
4.3 million new infections in 2006 with 2.8 million (65 percent) of these occurring in sub-Saharan Africa.
In 2006, 2.9 million people died of AIDS-related illnesses.
In South Africa, HIV/AIDS is the leading cause of child mortality and accounts for 40 to 60 percent of all deaths
nationwide, according to UNICEF.
mh/mjs
11/02/2007 12:58 GMT
http://www.turkishpress.com/news.asp?id=200674
74 UK
Wires
TB vaccine sickens HIV-infected children - report
Fri 2 Nov 2007, 20:27 GMT
WASHINGTON (Reuters) - A vaccine aimed at protecting children in
developing countries from deadly tuberculosis may be killing and
sickening some vulnerable infants infected with the AIDS virus,
They said the Bacille Calmette-Guerin or BCG vaccine, which is made
using a bovine version of tuberculosis, appeared to be causing serious
infections in some babies and young children who are HIV-infected.
including TB.
BILLIONS INFECTED
HIV-infected.
76 Reuters AlertNet
TB vaccine sickens HIV-infected children - report
Fri 2 Nov 2007, 20:27 GMT
WASHINGTON (Reuters) - A vaccine aimed at protecting children in developing countries from deadly
tuberculosis may be killing and sickening some vulnerable infants infected with the AIDS virus,
tuberculosis, appeared to be causing serious infections in some babies and young children who are HIVinfected.
including TB.
BILLIONS INFECTED
HIV-infected.
http://www.alertnet.org/thenews/newsdesk/N02648996.htm 78 UK
Print
79 10 November 2007
80 Co-epidemic a global health crisis
From The Times
November 2, 2007
Mark Henderson
GENEVA About 13 million people worldwide are infected with both HIV and tuberculosis (TB), in a deadly
co-epidemic that deserves to be seen as a global health crisis in its own right, according to a report from
the International Aids Society.
The mortality rate among people with both diseases is five times higher than those who have TB alone,
and co-infections may also be feeding the rise of drug-resistant strains of TB bacteria. Most health
systems in sub-Saharan Africa, the worst-affected region, are incapable of diagnosing, treating or
containing the co-epidemic, and research is needed urgently to develop new tests and therapies, the
report says.
HIV-TB is thought to affect about a third of the 40 million people living with HIV. Without the right
treatment, 90 per cent of those who contract TB while infected with HIV die within a few months.
Standard diagnostic tests fail to detect between 40 and 80 per cent of TB infections when HIV is also
present. New tests that can diagnose TB and its drug-resistant strains quickly are essential, the report
says.
81 UK
Online
BBC News (UK)
http://news.bbc.co.uk/1/hi/world/africa/7074298.stm
Dual epidemic threatening Africa
A rising number of dual infections with HIV and
tuberculosis has created a co-epidemic spreading
throughout sub-Saharan Africa, researchers say.
Local health systems are unable to contain the co-epidemic,
the Forum for Collaborative HIV Research says.
The situation is made more urgent by increasing rates of
drug-resistant TB in areas with a high prevalence of HIV.
Half of all new TB cases in sub-Saharan Africa are now HIV
co-infected, forum director Veronica Miller said.
Contagious
TB, which is a disease of the respiratory system, is not
uncommon - about 20% of the world's population has it but
most will not develop the disease.
Poor areas of sub-Saharan Africa are
vulnerable
However in Africa's slums, where people live crammed together in tin shacks, TB is rife, the
report notes.
Because HIV has destroyed the immune systems of at least a quarter of the population in
some areas, far more people are not only developing TB but spreading it to otherwise
healthy neighbours.
The BBC's Peter Greste in Cape Town says areas around the South African city are among
the worst affected.
In one community in the western Cape, a child is 100 times more likely to contract TB than
anyone living in the developed world.
But one Cape Town-based researcher, Dr Stephen Lawn, says existing tests often cannot
spot TB before it is too late and health care systems cannot cope.
Without proper treatment, the Forum for Collaborative HIV Research says, 90% of people
with HIV die within months of contracting TB.
82 Viernes, 2 de noviembre de 2007 - 05:37 GMT
"Doble epidemia" amenaza a África
Muchos casos de tuberculosis son resistentes a los medicamentos.
Un creciente número de infecciones simultáneas con VIH y tuberculosis ha creado una coepidemia que se extiende a través del África subsahariana, indicaron investigadores.
Los sistemas locales de salud están siendo incapaces de contener la co-epidemia, dijo el Foro para
Investigación Cooperativa de VIH.
La situación se torna más urgente por las crecientes tasas de tuberculosis resistente a los medicamentos
en zonas con alta prevalencia de VIH.
La mitad de todos los nuevos casos de tuberculosis en África subsahariana presentan también coinfección con VIH, aseguró la directora del foro, Verónica Miller.
Contagioso
zonas.
83 El corresponsal de la BBC en Ciudad del Cabo, Peter Greste, informa que zonas en esa ciudad
desarrollado.
médicos actualmente utilizados allí frecuentemente no consiguen identificar la tuberculosis antes de que
sea demasiado tarde.
http://news.bbc.co.uk/hi/spanish/science/newsid_7074000/7074325.stm
84 NewScientist.com
TB vaccine poses threat to HIV-positive babies
16:25 02 November 2007
NewScientist.com news service
Roxanne Khamsi
A vaccine meant to protect against tuberculosis is jeopardising the lives of HIV-infected infants, warn experts in
a major new report. They call for improvements to vaccination programmes to avoid increasing the health risks
for children whose immune systems are weakened by HIV.
The report focuses on how the “global epidemics of HIV and tuberculosis has exploded to create a deadly coepidemic”, that is rapidly spreading in sub-Saharan Africa. It warns that about a third of the world’s 40 million
people with HIV/AIDS are co-infected with TB, and that the mortality rate these people is five times higher than
that for tuberculosis alone.
It also notes that the use of the Bacille Calmette-Guérin (BCG) vaccine against TB in babies with HIV may
actually be making the situation worse.
Veronica Miller, a co-author of the report and director of the Washington, DC-based Forum for Collaborative
HIV Research, said that there is an "urgent" need for changes to vaccination programmes in sub-Saharan
Africa, including improved testing to know whether infants have HIV before vaccinating them against TB.
Live strain
The growing threat of TB and the drug-resistant forms of this bacterial infection that commonly attacks the
lungs has increased the need for widespread vaccination, experts say.
Unfortunately, there is a lack of new vaccines against TB, which kills nearly 2 million people each year. For this
reason, doctors must rely on the BCG vaccine, developed almost a century ago from a usually non-pathogenic,
live strain of Mycobacterium bovis – the cow form of the bacterium that causes TB.
Physicians routinely administer this vaccine to newborns in regions where TB has re-emerged as a threat. This
means that millions of infants in developing nations in Africa and Asia receive the vaccine in their first few hours
of life.
Unfortunately, though, many of these infants are born with HIV, and subsequently have a weakened immune
system. This weakened condition makes them vulnerable to “BCG disease”, a serious illness caused by the M.
bovis of the BCG vaccine, which would otherwise not pose a threat.
BCG disease
One recent study conducted in South Africa and published in the journal Clinical Infectious Diseases found that
six out of the eight children that became severely ill from the BCG vaccine ultimately died from the M. bovis
infection (vol 15, p 559-61). The majority of these children were found to have had HIV.
85 Miller says that an estimated 600,000 children are born with HIV each year and hundreds are at risk of dying as
a consequence of BCG vaccination.
The World Health Organization (WHO) had previously recommended that the BCG vaccine be given to all
healthy infants as soon as possible after birth. However, the WHO revised its position and stated in a May 2007
report that "recent evidence shows that children who were HIV-infected when vaccinated with BCG at birth, and
who later developed AIDS, were at increased risk of developing BCG disease."
The report adds that, "among these children, the benefits of potentially preventing severe TB are outweighed
by the risks associated with the use of BCG vaccine."
Sophisticated tests
The challenge is to develop more sophisticated HIV tests for newborns, says Miller, who also conducts
research at George Washington University in Washington, DC, US. But this will take a bigger financial
commitment from governments and aid organisations, she adds.
She explains that the types of HIV tests commonly used in the developing world cannot distinguish the HIV
status of infants until they reach about six months of age.
The search for more effective tuberculosis vaccines could produce novel options that avoid the problem of
BCG-related illness, says Lewellys Barker at the Aeras Global TB Vaccine Foundation in Rockville, Maryland,
US.
He notes that scientists are designing TB vaccines that involve the injection of proteins, as opposed to live
bacteria, which would not pose as great a threat to children with HIV.
Journal reference: HIV-TB Co-Infection: Meeting the Challenge (pdf)
HIV and AIDS - Learn more about the worst pandemic in human history in our continuously updated
special report.
http://www.newscientist.com/channel/health/hiv/dn12871-tb-vaccine-poses-threat-to-hivpositivebabies.html
86 USA
Wires
Twin Epidemic Of HIV And TB Threatens Africa
November 2, 2007 9:02 a.m. EST
Annabella Bulacan - AHN News Writer
(AHN)- Half of the new tuberculosis cases in sub-Saharan Africa are now HIV (human immunodeficiency
virus) co-infected, the Forum for Collaborative Research reported on Thursday.
The research noted the dual epidemic are threatening the lives of millions of people in the region,
especially in slum areas where both TB and HIV are rife.
"Because HIV has destroyed the immune systems of at least a quarter of the population in some areas,
far more people are not only developing TB but spreading it to otherwise healthy neighbours," the report
noted as quoted by BBC News.
Forum director Veronica Miller warned that 90 percent of people with HIV die in a short span of time of
contracting tuberculosis.
In a poor country like Africa, a child is 100 times more likely to contract TB than anyone living in a more
developed region.
87 Thousands Gather at TB Meet in S. Africa
By CLARE NULLIS
Wednesday, November 7, 2007; 8:24 AM
strains.
against TB.
administration.
Department.
The Treatment Action Group said the lack of funding was especially alarming given the global spread of
88 The spread of the drug resistant forms of TB is largely the result of poorly managed TB care and patients
immune systems.
89 HIV, TB Co-epidemic Poses Global Health Crisis - Reports
2 November 2007
About 13 million people worldwide are infected with both HIV and tuberculosis, in a deadly co-epidemic
that deserves to be seen as a global health crisis in its own right, according to a report from the
International Aids Society, U.K. media report Friday.
The mortality rate among people with both diseases is five times higher than those who have TB alone,
and co-infections may also be feeding the rise of drug-resistant strains of TB bacteria, The Times of
London says.
The co-epidemic is spreading throughout sub-Saharan Africa, the BBC quotes the Forum for
Collaborative HIV Research as saying. Half of all new TB cases in sub-Saharan Africa are now HIV coinfected, forum director Veronica Miller is cited as saying on the BBC Web site. Local health systems are
unable to contain the co-epidemic, the BBC reports.
HIV-TB is thought to affect about a third of the 40 million people living with HIV. Without the right
treatment, 90% of those who contract TB while infected with HIV die within a few months, The Times of
London cites from the report.
Web site: http://news.bbc.co.uk
Newspaper Web site: http://www.timesonline.co.uk
-Berlin Bureau, Dow Jones Newswires; +49 30 288 8410 [ 02-11-07 0931GMT ]
90 Top News
HIV and TB emerge as African epidemic
CAPE TOWN, South Africa, Nov. 2 (UPI) -- Cape Town, South Africa, is among the worst cities
in the region affected by a epidemic of HIV and drug-resistant tuberculosis.
The BBC in Cape Town reported that children in the city’s slums are 100 times more likely to
contract TB than elsewhere in the world.
A researcher working in the area says 90 percent of those who have both TB and HIV die within
months if not afforded proper treatment.
Officials with the Forum for Collaborative HIV research said the situation is impacted by the
deterioration of the immune system by HIV infection in coordination with increasingly drug
resistance strains of TB.
Veronica Miller, direct of the forum, told the BBC that half of the recent TB infections are also
infected with HIV.
http://www.upi.com/NewsTrack/Top_News/2007/11/02/hiv_and_tb_emerge_as_african_epidemic/5415/
91 USA
Print
AIDS Weekly & Law
November 22, 2007
HIV/AIDS CO-INFECTION;
HIV-TB spreads in Africa, undermines control of world's 2 deadliest
infectious diseases
SECTION: EXPANDED REPORTING; Pg. 62
LENGTH: 2193 words
The largely unnoticed collision of the global epidemics of HIV and tuberculosis (TB) has exploded to
create a deadly co-epidemic that is rapidly spreading in sub-Saharan Africa. However, health systems
cannot adequately diagnose, treat, or contain the co-epidemic due to unanswered scientific and medical
questions, according to a report issued today by The Forum for Collaborative HIV Research and amplified
by experts from leading global health organizations (see also HIV/AIDS Co-Infection).
Approximately one-third of the world 's 40 million people with HIV/AIDS are co-infected with TB, and the
mortality rate for HIV-TB co-infection is five-fold higher than that for tuberculosis alone. This situation is
made yet more urgent by the surging rates of multi-drug resistant TB in some areas with high HIV
prevalence, according to the report.
where drug-resistant TB is silently spreading," said Veronica Miller, coauthor of the report and director of
The Forum for Collaborative HIV Research, a global independent public-private partnership comprised of
researchers, patient advocates, and government and industry representatives. "Unlike bird flu, the global
threat of HIV/TB is not hypothetical. It is here now. But the science and coordination needed to stop it are
utterly insufficient."
The new report, titled "HIV-TB Co-Infection: Meeting the Challenge," is based on a symposium and
roundtable discussion held in Sydney, Australia, during the International Aids Society (IAS) conference in
July 2007. Along with the Forum for Collaborative HIV Research, many of the world 's leading global
health organizations co-sponsored these events, including the Agence Nationale de Recherches sur le
Sida et les H épatites Virales (ANRS) in France, the Bill & Melinda Gates Foundation, CREATE
(Consortium to Respond Effectively to the AIDS-TB Epidemic), the European and Developing Countries
Clinical Trials Partnership (EDCTP), the International AIDS Society, Tibotec, the U.S. National Institutes
of Health, and the World Health Organization 's (WHO) TB/HIV Working Group of the Stop TB
Partnership.
The rapid spread of HIV-TB is due to the geography and biology of co-infection. One-third of the global
population -approximately two billion people -are infected with TB. But in the vast majority of those
infected, the disease is latent, walled off by the body 's immune system. Only one-in-ten people infected
with TB develop active disease in their lifetime. HIV changes this equation. Of those whose immune
systems have been weakened by HIV, 10 percent will develop active TB each year.
92 "In today 's world, a new TB infection occurs every second. When one considers that much of this
clear," said Diane Havlir, Chair of the WHO TB/HIV Working Group.
rates of HIV. For example, in one community of 13,000 people outside of Cape Town, South Africa, the
TB patient caseload increased six-fold between 1996 and 2004, from 30 to 180 per year. Rates of TB in
this community are over 150-fold higher than the national rates in many high-income countries.
southern Africa," said Stephen Lawn, a medical researcher at the University of Cape Town in South
Africa.
The co-epidemic represents a setback to global control of tuberculosis, which would otherwise be in
global decline.
HIV and Multi-drug Resistant TB Earlier this year, the U.S. Centers for Disease Control and Prevention
mounted a massive effort to stop the international travels of one man suspected of carrying XDR-TB. Yet,
according to the report, rates of multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant
TB (XDR-TB) are increasing dramatically and are often associated with HIV co-infection. (MDR-TB is
resistant to the top two TB drugs, and XDR-TB is resistant to the vast majority of first- and second-line
drugs.)
The report cites an outbreak of HIV/XDR-TB in Tugela Ferry, South Africa, where the number of cases
has increased five-fold in the last two years. All of the 53 people originally diagnosed with XDR-TB in this
outbreak were co-infected with HIV. They suffered an extremely high mortality rate of 98 percent, and
survived only an average of 16 days from the time of diagnosis. Since then, over 450 cases of MDR-TB
have been reported in Tugela Ferry, of which 55 percent are XDR-TB cases, most co-infected with HIV.
The mortality rate for XDR-TB has dropped slightly but is still high at approximately 85 percent, and even
mortality rates among MDR-TB cases in this setting remain alarmingly high, approaching 70 percent.
2007, XDR-TB had been confirmed in 41 countries, up from 17 countries in March 2006. There are now
an estimated 400,000 individuals infected with MDR-TB and 26,000 infected with XDR-TB. But these
numbers underestimate the problem, since there is no data from many high HIV prevalence areas.
"The mortality rate from extensively drug-resistant TB in combination with HIV is staggering, with more
than 80 percent of patients dying rapidly," said Richard Chaisson, Director of CREATE. "Despite the
urgency and severity of the problem, we have neither the drug testing nor the surveillance tools in place
to know the full extent of XDR-TB and HIV across large areas of Africa."
According to the report, South Africa is the only country in sub-Saharan Africa with the laboratory capacity
to diagnose XDR-TB. In addition, the report calls for the use of outbreak investigative methods to map out
hotspots of HIV and drug-resistant TB.
Key Medical and Scientific Challenges Co-infection with HIV-TB presents serious medical and scientific
challenges, among them difficulties in diagnosis, infection control, and managing co-toxicities between
drugs previously used to independently treat the two diseases. All of these problems are heightened in
children. In addition, most treatment programs remain targeted at either HIV or TB, and clinics for each
are often miles apart.
"We need integrated HIV-TB services using primary health care to reach the broad population," Havlir
said. "This means we need not only basic and clinical research into HIV-TB, but also research now to
determine the best models for care delivery."
93 Diagnosis of HIV-TB
Detection of TB is further complicated by atypical symptoms in people who are co-infected. In coinfection, TB is less likely to cause typical lung disease and more likely to cause "disseminated TB,"
TB in HIV-Infected Children Almost one-quarter of HIV-infected children develop TB every year and drugresistant TB among children is increasing, according to the report. Many unanswered questions remain in
the diagnosis and treatment of pediatric HIV-TB co-infection, and there is a lack of pediatric drug
formulations for both TB and HIV drugs. Despite all this, very few clinical trials of childhood TB have been
conducted to optimize diagnosis or treatment outcomes.
"Nearly every infant with HIV suffers from pneumonia. TB also causes acute pneumonia, but with our
current tools it is hard to know what is and is not caused by TB," said Mark Cotton, a pediatrician and HIV
researcher at Stellenbosch University in South Africa. "Children should be included in trials to evaluate
new anti-TB drugs."
A further cause for concern is the use of the Bacille Calmette-Gu érin (BCG) vaccine in children, the
report says. The vaccine provides some protection against disseminated TB in children. Therefore, based
on WHO recommendations, BCG is given once at birth in most developing countries. But recent studies
"One study found a 75 percent mortality rate in children with BCG disease, and 70 percent of those
children were HIV-infected. Clearly, this is a problem in need of immediate attention," Cotton said.
Infection Control A medicine that appears to prevent active disease in HIV/TB co-infected patients, thus
aiding infection control, is practically unused for this purpose, says the report. The medicine, Isoniazid, is
a front-line drug used to treat TB. But concerns about Isoniazid Preventive Therapy (IPT) are such that
Botswana is the only country in sub-Saharan Africa to use IPT nationally. These concerns include the
potential for IPT-related drug resistance, the short duration of IPT efficacy, and the difficulties in ruling out
active TB in co-infected people.
"Research that definitively addresses these concerns is needed now, in order to make this tool available
or come up with alternatives to control the spread of infection," Lawn said.
What Is Needed According to the report, key multilateral, government, scientific and donor organizations
are beginning to strengthen their commitments to fighting HIV-TB, but much more remains to be done.
The report summarizes the role and commitments of the leading global health organizations that
participated in the roundtable discussion.
"Urgent action on the part of funding agencies, researchers, policy makers, drug companies and
communities is needed to face the challenge posed by the dual epidemic of HIV-TB," Miller said. "The fact
that all these organizations have begun to jointly tackle the challenge of HIV-TB shows that the walls
between the two diseases are finally coming down. We must scale those walls, or the HIV-TB coepidemic will continue to overwhelm us."
The report outlines key research questions and other measures needed to stem the HIV-TB co-epidemic.
These include:
94 Research to develop safe rapid diagnostic tests to detect both drug-susceptible and drug-resistant TB, for
use in HIV-infected adults and children at the point of care.
Development of screening tools to identify potential cases of MDR/XDR-TB.
Equipping laboratories to be able to diagnose MDR and XDR-TB.
Use of outbreak investigative methods to rapidly map out hotspots of HIV and drug- resistant TB, rather
than relying upon standard surveillance methods.
Research addressing practical questions, such as ventilation, that can facilitate implementation of
infection control procedures in health care facilities
Research into diagnostic tools to exclude active TB before initiation of Isoniazid Preventive Therapy (IPT)
in HIV-infected patients, in order to avoid under treating active TB, which could lead to drug resistance.
Authoritative studies to determine the risk of IPT causing isoniazid resistance.
Research to better understand TB and HIV drug interactions in adults and children and to optimize
treatment in both groups.
Studies on the virological, immunological, and microbiological outcomes of HIV- TB co-infection in
children.
Evaluation of BCG vaccination in HIV-infected children.
Research to provide evidence-based models for HIV-TB programs at local, district, and national levels, in
rural areas and cities, to demonstrate ways in which HIV and TB programs can positively interact and
deliver services.
Resources, advocacy, and community mobilization to push for implementation and to prioritize the HIV/TB
research agenda.
Keywords: HIV/AIDS Co-Infection, AIDS, Acquired Immunodeficiency Syndrome, Adverse Drug Effect,
Adverse Drug Event, Adverse Drug Reaction, Clinical Trial Research, Cutaneous Tuberculosis, Drug
Development, HIV, Human Immunodeficiency Virus Bacterial Infection, Infectious Disease, Mycobacteria,
Mycobacterium Tuberculosis, Therapy, Travel Health, Travel Immunization, Travel Vaccination,
Treatment, Vaccine Safety, Virology, Burness Communications.
This article was prepared by AIDS Week & Law editors from staff and other reports. Copyright 2007,
AIDS Week & Law via NewsRx.com.
95 96 Pharma Marketletter
November 7, 2007 Wednesday
Co-epidemic of HIV-TB spreading in Africa, says US report
LENGTH: 464 words
The largely unnoticed collision of the global epidemics of HIV and tuberculosis has created a deadly coepidemic that is rapidly spreading in sub-Saharan Africa. However, health systems cannot adequately
diagnose, treat or contain the co-epidemic due to unanswered scientific and medical questions, according
to a report issued by the Forum for Collaborative HIV Research.
Approximately one-third of the world's 40 million people with HIV/AIDS are co-infected with TB, and the
where drug-resistant TB is silently spreading," said Veronica Miller, co-author of the report and director of
threat of HIV/TB is not hypothetical. It is here now. But the science and coordination needed to stop it are
utterly insufficient," she added,
HIV. Without proper treatment, 90% of people living with HIV die within months of contracting TB.
The new report, titled HIV-TB Co-Infection: Meeting the Challenge, is based on a symposium and
roundtable discussion held in Sydney, Australia, during the International Aids Society conference in July
2007. Along with the Forum for Collaborative HIV Research, many of the world's leading global health
organizations co-sponsored these events, including the Agence Nationale de Recherches sur le Sida et
les Hepatites Virales in France, the Bill & Melinda Gates Foundation, the Consortium to Respond
Effectively to the AIDS-TB Epidemic, the European and Developing Countries Clinical Trials Partnership,
the International AIDS Society, Irish drugmaker Tibotec, the US National Institutes of Health, and the
World Health Organization's TB/HIV Working Group belonging to the Stop TB Partnership.
The rapid spread of HIV-TB is due to the geography and biology of co-infection. One-third of the global
population - approximately two billion people - are infected with TB. But in the vast majority of those
infected, the disease is latent, walled off by the body's immune system. Only one-in-10 people infected
systems have been weakened by HIV, 10% will develop active TB each year, the report authors noted.
97 98 USA
Online
Co-epidemic of HIV-TB Spreading in Africa, Undermining Global
Control of World's Two Deadliest Infectious Diseases
The Forum for Collaborative HIV Research (Washington, DC)
PRESS RELEASE
2 November 2007
Posted to the web 2 November 2007
Washington, DC
The largely unnoticed collision of the global epidemics of HIV and tuberculosis (TB) has exploded to
create a deadly co-epidemic that is rapidly spreading in sub-Saharan Africa. However, health systems
cannot adequately diagnose, treat, or contain the co-epidemic due to unanswered scientific and medical
questions, according to a report issued today by The Forum for Collaborative HIV Research and amplified
by experts from leading global health organizations.
Approximately one-third of the world's 40 million people with HIV/AIDS are co-infected with TB, and the
where drug-resistant TB is silently spreading," said Veronica Miller, coauthor of the report and director of
threat of HIV/TB is not hypothetical. It is here now. But the science and coordination needed to stop it
are utterly insufficient."
The new report, titled "HIV-TB Co-Infection: Meeting the Challenge," is based on a symposium and
roundtable discussion held in Sydney, Australia, during the International Aids Society (IAS) conference in
July 2007. Along with the Forum for Collaborative HIV Research, many of the world's leading global
health organizations co-sponsored these events, including the Agence Nationale de Recherches sur le
Sida et les Hépatites Virales (ANRS) in France, the Bill & Melinda Gates Foundation, CREATE
(Consortium to Respond Effectively to the AIDS-TB Epidemic), the European and Developing Countries
Clinical Trials Partnership (EDCTP), the International AIDS Society, Tibotec, the U.S. National Institutes
of Health, and the World Health Organization's (WHO) TB/HIV Working Group of the Stop TB
Partnership.
99 The rapid spread of HIV-TB is due to the geography and biology of co-infection. One-third of the global
population—approximately two billion people—are infected with TB. But in the vast majority of those
infected, the disease is latent, walled off by the body's immune system. Only one-in-ten people infected
systems have been weakened by HIV, 10 percent will develop active TB each year.
"In today's world, a new TB infection occurs every second. When one considers that much of this
clear," said Diane Havlir, Chair of the WHO TB/HIV Working Group.
rates of HIV. For example, in one community of 13,000 people outside of Cape Town, South Africa, the
TB patient caseload increased six-fold between 1996 and 2004, from 30 to 180 per year. Rates of TB in
this community are over 150-fold higher than the national rates in many high-income countries.
southern Africa," said Stephen Lawn, a medical researcher at the University of Cape Town in South
Africa.
The co-epidemic represents a setback to global control of tuberculosis, which would otherwise be in
global decline.
HIV and Multi-drug Resistant TB
Earlier this year, the U.S. Centers for Disease Control and Prevention mounted a massive effort to stop
the international travels of one man suspected of carrying XDR-TB. Yet, according to the report, rates of
multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) are increasing
dramatically and are often associated with HIV co-infection. (MDR-TB is resistant to the top two TB
drugs, and XDR-TB is resistant to the vast majority of first- and second-line drugs.)
The report cites an outbreak of HIV/XDR-TB in Tugela Ferry, South Africa, where the number of cases
has increased five-fold in the last two years. All of the 53 people originally diagnosed with XDR-TB in this
outbreak were co-infected with HIV. They suffered an extremely high mortality rate of 98 percent, and
survived only an average of 16 days from the time of diagnosis. Since then, over 450 cases of MDR-TB
have been reported in Tugela Ferry, of which 55 percent are XDR-TB cases, most co-infected with HIV.
The mortality rate for XDR-TB has dropped slightly but is still high at approximately 85 percent, and even
mortality rates among MDR-TB cases in this setting remain alarmingly high, approaching 70 percent.
2007, XDR-TB had been confirmed in 41 countries, up from 17 countries in March 2006. There are now
an estimated 400,000 individuals infected with MDR-TB and 26,000 infected with XDR-TB. But these
numbers underestimate the problem, since there is no data from many high HIV prevalence areas.
"The mortality rate from extensively drug-resistant TB in combination with HIV is staggering, with more
than 80 percent of patients dying rapidly," said Richard Chaisson, Director of CREATE. "Despite the
urgency and severity of the problem, we have neither the drug testing nor the surveillance tools in place
to know the full extent of XDR-TB and HIV across large areas of Africa."
According to the report, South Africa is the only country in sub-Saharan Africa with the laboratory capacity
to diagnose XDR-TB. In addition, the report calls for the use of outbreak investigative methods to map
out hotspots of HIV and drug-resistant TB.
100 Key Medical and Scientific Challenges
Co-infection with HIV-TB presents serious medical and scientific challenges, among them difficulties in
diagnosis, infection control, and managing co-toxicities between drugs previously used to independently
treat the two diseases. All of these problems are heightened in children. In addition, most treatment
programs remain targeted at either HIV or TB, and clinics for each are often miles apart.
"We need integrated HIV-TB services using primary health care to reach the broad population," Havlir
said. "This means we need not only basic and clinical research into HIV-TB, but also research now to
determine the best models for care delivery."
Diagnosis of HIV-TB
Detection of TB is further complicated by atypical symptoms in people who are co-infected. In coinfection, TB is less likely to cause typical lung disease and more likely to cause "disseminated TB,"
TB in HIV-Infected Children
Almost one-quarter of HIV-infected children develop TB every year and drug-resistant TB among children
is increasing, according to the report. Many unanswered questions remain in the diagnosis and treatment
of pediatric HIV-TB co-infection, and there is a lack of pediatric drug formulations for both TB and HIV
drugs. Despite all this, very few clinical trials of childhood TB have been conducted to optimize diagnosis
or treatment outcomes.
"Nearly every infant with HIV suffers from pneumonia. TB also causes acute pneumonia, but with our
current tools it is hard to know what is and is not caused by TB," said Mark Cotton, a pediatrician and HIV
researcher at Stellenbosch University in South Africa. "Children should be included in trials to evaluate
new anti-TB drugs."
A further cause for concern is the use of the Bacille Calmette-Guérin (BCG) vaccine in children, the report
says. The vaccine provides some protection against disseminated TB in children. Therefore, based on
WHO recommendations, BCG is given once at birth in most developing countries. But recent studies
"One study found a 75 percent mortality rate in children with BCG disease, and 70 percent of those
children were HIV-infected. Clearly, this is a problem in need of immediate attention," Cotton said.
Infection Control
A medicine that appears to prevent active disease in HIV/TB co-infected patients, thus aiding infection
control, is practically unused for this purpose, says the report. The medicine, Isoniazid, is a front-line
101 drug used to treat TB. But concerns about Isoniazid Preventive Therapy (IPT) are such that Botswana is
the only country in sub-Saharan Africa to use IPT nationally. These concerns include the potential for
IPT-related drug resistance, the short duration of IPT efficacy, and the difficulties in ruling out active TB in
co-infected people.
"Research that definitively addresses these concerns is needed now, in order to make this tool available
or come up with alternatives to control the spread of infection," Lawn said.
What Is Needed
According to the report, key multilateral, government, scientific and donor organizations are beginning to
strengthen their commitments to fighting HIV-TB, but much more remains to be done. The report
summarizes the role and commitments of the leading global health organizations that participated in the
roundtable discussion.
"Urgent action on the part of funding agencies, researchers, policy makers, drug companies and
communities is needed to face the challenge posed by the dual epidemic of HIV-TB," Miller said. "The fact
that all these organizations have begun to jointly tackle the challenge of HIV-TB shows that the walls
between the two diseases are finally coming down. We must scale those walls, or the HIV-TB coepidemic will continue to overwhelm us."
The report outlines key research questions and other measures needed to stem the HIV-TB co-epidemic.
These include:
•
Research to develop safe rapid diagnostic tests to detect both drug-susceptible and
resistant TB, for use in HIV-infected adults and children at the point of care.
•
Development of screening tools to identify potential cases of MDR/XDR-TB.
•
Equipping laboratories to be able to diagnose MDR and XDR-TB.
•
Use of outbreak investigative methods to rapidly map out hotspots of HIV and drugTB, rather than relying upon standard surveillance methods.
•
Research addressing practical questions, such as ventilation, that can facilitate
of infection control procedures in health care facilities
•
Research into diagnostic tools to exclude active TB before initiation of Isoniazid Preventive
Therapy (IPT) in HIV-infected patients, in order to avoid under treating active TB, which could
lead to drug resistance.
•
Authoritative studies to determine the risk of IPT causing isoniazid resistance.
•
Research to better understand TB and HIV drug interactions in adults and children
optimize treatment in both groups.
•
Studies on the virological, immunological, and microbiological outcomes of HIVin children.
•
Evaluation of BCG vaccination in HIV-infected children.
102 drug-
resistant
implementation
and to
TB co-infection
•
Research to provide evidence-based models for HIV-TB programs at local, district, and national
levels, in rural areas and cities, to demonstrate ways in which HIV and TB programs can
positively interact and deliver services.
•
Resources, advocacy, and community mobilization to push for implementation and to prioritize
the HIV/TB research agenda.
The Forum for Collaborative HIV Research is an independent public-private partnership whose mission is
to facilitate discussion on emerging issues in HIV clinical research and the transfer of research results
into care. It is comprised of international experts from government agencies, pharmaceutical companies,
academia, advocacy and community organizations, and private foundations. The Forum is housed in the
Department of Prevention and Community Health at The George Washington University School of Public
Health and Health Services. For further information, visit: www.hivforum.org and click on "HIV-TB Coinfection: Meeting the Challenge."
Read the Report
103 CBS News Online
By CLARE NULLIS
Wednesday, November 7, 2007; 8:24 AM
strains.
against TB.
administration.
Department.
immune systems.
105 Dual Threat Faces African Countries
Posted Nov 2, 2007 by
permafrog in World | 5 comments | 128 views
Dual infections of HIV and tuberculosis are on the rise
and this has created a co-epidemic which is spreading
throughout sub-Saharan Africa, researchers say.
Withour proper treatment 90% of people with HIV die
within months of contracting TB.
By themselves HIV and tuberculosis (TB) present a serious
threat; when they are spreading together in a co-epidemic
the threat multiples.
This is exactly what is happening throughout sub-Saharan
Africa. The local health systems are unable to cope with
Africa
this dual threat, according to the Forum for Collaborative
HIV Research.
Veronica Miller the Forum’s director has stated that half of
all new TB cases in sub-Saharan Africa are now HIV co-infected.
A respiratory system disease TB is not an uncommon disease approximately 20% of the world's
population has it but most will not develop the disease.
The situation is much different in the slums of many African cities, there in the crowded conditions, TB
runs free.
HIV will or has destroyed the immune systems of at least one-quarter of the population in some areas and
now increased numbers of people are getting TB and passing it on to their otherwise healthy neighbours.
According to a BBC report areas around the South African city of Cape Town are among the worst
affected.
In the Western Cape, in one community a child is 100 times more likely to contract TB than anyone living
in the developed world.
106 Dr Stephen Lawn, a researcher based in Cape Town says existing tests often cannot spot TB before it is
too late and health care systems cannot cope.
If proper treatment cannot be provided then, the Forum for Collaborative HIV Research says, 90% of
people with HIV die within months of contracting TB.
http://digitaljournal.com/article/244863/Dual_Threat_Faces_African_Countries
By CLARE NULLIS
strains.
against TB.
administration.
Department.
immune systems.
By CLARE NULLIS
strains.
against TB.
administration.
Department.
immune systems.
111 Weekly TB/Malaria Report
Tuberculosis | HIV/TB Co-Epidemic Rapidly Spreading in SubSaharan Africa, Report Says [November 2, 2007] About one-third of the approximately 40 million HIV-positive people worldwide also are
living with tuberculosis, according to a report released Thursday by the Forum for
Collaborative HIV Research, IANS/Yahoo! News reports. According to the report, the
HIV/TB co-epidemic rapidly is spreading in sub-Saharan Africa, where the threat of the two
diseases largely has gone unnoticed (IANS/Yahoo! News, 11/2).
The report, titled "HIV-TB Co-Infection: Meeting the Challenge," is based on a symposium
and roundtable discussion held in Sydney, Australia, during the 4th IAS Conference on HIV
Pathogenesis, Treatment and Prevention in July (FCHR release (.pdf), 11/2). According to
the report, deaths from HIV/TB coinfection are five times higher than deaths from TB alone
(IANS/Yahoo! News, 11/2). In addition, the report also noted that about half of all new TB
cases in sub-Saharan Africa occur among HIV-positive people. HIV/TB coinfection also
could be fueling the increase in drug-resistant strains of TB, the report said (Dow Jones,
11/2). About 10% of people living with HIV/AIDS develop TB annually, according to the
report (FCHR release, 11/2). About 90% of people living with HIV/AIDS will die within
months of contracting TB, Stephen Lawn, a researcher at the University of Cape Town, said
(BBC News, 11/2).
According to the report, many countries in sub-Saharan Africa lack the infrastructure to
adequately diagnose, treat or contain the HIV/TB co-epidemic (IANS/Yahoo! News, 11/2).
In addition, South Africa is the only country in sub-Saharan Africa with the laboratory
capacity to diagnose extensively drug-resistant tuberculosis, which is resistant to the two
most potent first-line treatments and some of the available second-line drugs.
The report recommends the use of outbreak-investigation methods to map areas with high
prevalence of HIV and drug-resistant TB. The report also calls on governments, scientific
bodies and donor organizations to strengthen commitments to fight HIV/TB coinfection. In
addition, the report recommends:
•
Developing rapid diagnostic tests to detect drug-susceptible and drug-resistant TB
in HIV-positive adults and children;
•
Developing screening tools and equipping labs with tools to diagnose multi-drug
resistant TB and XDR-TB;
112 •
Researching ways to prevent the spread of TB in health care facilities;
•
Researching diagnostic tools to determine whether a patient has active TB before
beginning isoniazid preventive therapy among HIV-positive people;
•
Optimizing treatment of HIV/TB coinfection by better understanding TB and HIV
drug interactions;
•
Studying the virological, immunological and microbiological outcomes of HIV/TB
coinfection in children;
•
Providing evidence-based models for HIV/TB coinfection programs at local, district
and national levels;
•
Mobilizing communities to place priority on HIV/TB coinfection research and
implementing programs to treat HIV/TB coinfection (FCHR release, 11/2).
Reaction
Veronica Miller, a report author and director of FCHR, said that the "global threat of HIV/TB
[coinfection] is not hypothetical. It is here now. But the science and coordination needed to
stop it are utterly insufficient" (IANS/Yahoo! News, 11/2). Diane Havlir, chair of the World
Health Organization's TB/HIV Working Group, added that health systems "need integrated
HIV/TB services using primary health care to reach the broad population," including
research to "determine the best models for care delivery."
Miller said that donor organizations' efforts to "jointly tackle the challenge of HIV/TB
[coinfection] shows that the walls between the two diseases are finally coming down,"
adding that the global health community "must scale those walls, or the HIV/TB coepidemic will continue to overwhelm us" (FCHR release, 11/2).
The report is available online (.pdf).
http://www.globalhealthreporting.org/article.asp?DR_ID=48620
113 Houston Chronicle Online
By CLARE NULLIS
strains.
against TB.
administration.
Department.
114 In South Africa, for instance, the cure rate for patients who stick to their treatment is just 50 percent, way
immune systems.
115 Kaiser Daily HIV/AIDS Report
Global Challenges | HIV/TB Co-Epidemic Rapidly Spreading in Sub-Saharan Africa, Report
Says
[Nov 02, 2007]
About one-third of the approximately 40 million HIV-positive people worldwide also are living with
tuberculosis, according to a report released Thursday by the Forum for Collaborative HIV Research,
IANS/Yahoo! News reports. According to the report, the HIV/TB co-epidemic rapidly is spreading in subSaharan Africa, where the threat of the two diseases largely has gone unnoticed (IANS/Yahoo! News,
11/2).
The report, titled "HIV-TB Co-Infection: Meeting the Challenge," is based on a symposium and roundtable
discussion held in Sydney, Australia, during the 4th IAS Conference on HIV Pathogenesis, Treatment and
Prevention in July (FCHR release (.pdf), 11/2). According to the report, deaths from HIV/TB coinfection
are five times higher than deaths from TB alone (IANS/Yahoo! News, 11/2). In addition, the report also
noted that about half of all new TB cases in sub-Saharan Africa occur among HIV-positive people. HIV/TB
coinfection also could be fueling the increase in drug-resistant strains of TB, the report said (Dow Jones,
11/2). About 10% of people living with HIV/AIDS develop TB annually, according to the report (FCHR
release, 11/2). About 90% of people living with HIV/AIDS will die within months of contracting TB,
Stephen Lawn, a researcher at the University of Cape Town, said (BBC News, 11/2).
According to the report, many countries in sub-Saharan Africa lack the infrastructure to adequately
diagnose, treat or contain the HIV/TB co-epidemic (IANS/Yahoo! News, 11/2). In addition, South Africa is
the only country in sub-Saharan Africa with the laboratory capacity to diagnose extensively drug-resistant
tuberculosis, which is resistant to the two most potent first-line treatments and some of the available
second-line drugs.
The report recommends the use of outbreak-investigation methods to map areas with high prevalence of
HIV and drug-resistant TB. The report also calls on governments, scientific bodies and donor
organizations to strengthen commitments to fight HIV/TB coinfection. In addition, the report recommends:

Developing rapid diagnostic tests to detect drug-susceptible and drug-resistant TB in HIV-positive
adults and children;

Developing screening tools and equipping labs with tools to diagnose multi-drug resistant TB and
XDR-TB;

Researching ways to prevent the spread of TB in health care facilities;
116
Researching diagnostic tools to determine whether a patient has active TB before beginning
isoniazid preventive therapy among HIV-positive people;

Optimizing treatment of HIV/TB coinfection by better understanding TB and HIV drug interactions;

Studying the virological, immunological and microbiological outcomes of HIV/TB coinfection in
children;

Providing evidence-based models for HIV/TB coinfection programs at local, district and national
levels;

Mobilizing communities to place priority on HIV/TB coinfection research and implementing
programs to treat HIV/TB coinfection (FCHR release, 11/2).
Reaction
Veronica Miller, a report author and director of FCHR, said that the "global threat of HIV/TB [coinfection]
is not hypothetical. It is here now. But the science and coordination needed to stop it are utterly
insufficient" (IANS/Yahoo! News, 11/2). Diane Havlir, chair of the World Health Organization's TB/HIV
Working Group, added that health systems "need integrated HIV/TB services using primary health care to
reach the broad population," including research to "determine the best models for care delivery."
Miller said that donor organizations' efforts to "jointly tackle the challenge of HIV/TB [coinfection] shows
that the walls between the two diseases are finally coming down," adding that the global health
community "must scale those walls, or the HIV/TB co-epidemic will continue to overwhelm us" (FCHR
release, 11/2).
The report is available online (.pdf).
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=48613
117 Kaiser Daily HIV/AIDS Report
Science & Medicine | BCG Vaccine Causing Illness, Death Among HIV-Positive Infants,
Report Says
[Nov 06, 2007]
The BCG vaccine, which aims to prevent tuberculosis among children in developing countries, might
be causing illness and death among some HIV-positive infants, researchers said on Friday, the Los
Angeles Times reports. The findings are included in a report about the HIV/TB co-epidemic released
Thursday by the Forum for Collaborative HIV Research (Los Angeles Times, 11/3). The report said that
the "benefits of potentially preventing severe TB" among HIV-positive infants are "outweighed by the risks
associated with the use of BCG vaccine."
The World Health Organization previously recommended that all healthy infants receive the BCG vaccine
as soon as possible after birth. However, the agency released a report in May 2007 changing its position
because of evidence that HIV-positive infants had an increased risk of developing BCG disease. The
BCG vaccine is based on a weakened strain of the bacterium that causes TB in cattle. Many of the infants
who receive the vaccine are born HIV-positive and subsequently have compromised immune systems
that make them susceptible to BCG disease, which is caused by the bovine bacterium in the vaccine
(Khamsi, NewScientist.com, 11/2).
One study found that the vaccine had a 75% mortality rate among children with BCG disease and that
70% of those children were HIV-positive, Mark Cotton -- co-author of the forum's report and an HIV/AIDS
researcher at Stellenbosch University in South Africa -- said (Fox, Reuters, 11/2).
According to Cotton, an estimated 400 of every 100,000 HIV-positive infants in South Africa's Western
Cape province had become ill from the BCG vaccine, and it was unclear how widespread the problem
might be across Africa.
Reaction
"Clearly, this is a problem in need of immediate attention," Cotton said, adding, "It is especially a problem
where [there is] delayed access to diagnosis of HIV or delayed access to antiretroviral therapy." Cotton
said the optimal solution would be to have earlier diagnosis and treatment of HIV-positive infants
(Reuters, 11/2). Veronica Miller, a co-author of the report and director of the forum, said there is an
"urgent" need for changes to vaccination programs in sub-Saharan Africa, including improved testing to
determine if infants are HIV-positive before receiving the vaccination (NewScientist.com, 11/2).
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=48672
118 MSNBC.com
TB vaccine sickens some HIV-infected children
Shot is often given in developing countries before child's AIDS status known
updated 5:18 p.m. ET, Fri., Nov. 2, 2007
WASHINGTON - A vaccine aimed at protecting children in developing countries from deadly
tuberculosis may be sickening and killing some vulnerable infants infected with the AIDS virus,
tuberculosis, appeared to be causing serious infections in some babies and young children who
are HIV-infected.
"One study found a 75-percent mortality rate in children with BCG disease, and 70 percent of
those children were HIV-infected. Clearly, this is a problem in need of immediate attention," said
Dr. Mark Cotton, a pediatrician and HIV researcher at Stellenbosch University in South Africa.
Cotton's findings are part of a report issued on Friday about the health emergency caused
globally by the double whammy of HIV and TB.
The AIDS virus destroys the immune system, and tuberculosis has made a return globally
because of this. Usually a latent infection, activated TB can kill quickly.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV coinfected, and where drug-resistant TB is silently spreading," said Veronica Miller, director of The
Forum for Collaborative HIV Research, a global independent public-private group that includes
researchers, patient advocates, and government and industry.
119 The human immunodeficiency virus infects an estimated 40 million people globally. There is
no cure and when untreated, it steadily destroys the immune system. Patients are vulnerable to
a range of infections including TB.
Billions infected
TB infects one-third of the world's population. Without proper treatment, 90 percent of people
infected with both die within months.
Usually, tuberculosis only becomes an active infection in one out of 10 people over a lifetime. But
10 percent of HIV patients who also have TB develop activated tuberculosis every year.
The BCG vaccine is given at birth in most developing countries. But because it uses a live
microbe, in people with weakened immune systems it can itself cause disease.
"It is especially a problem where they have delayed access to diagnosis of HIV or delayed access
to antiretroviral therapy," Cotton said in a telephone interview.
"It also is quite hard to diagnose it," he added. "We don't know how widespread it is across
Africa."
Cotton said an estimated 400 per 100,000 HIV-infected infants in the Western Cape of South
Africa had become sick from the BCG vaccine.
"The problem is the vaccine is usually given within the first few days of life," Cotton said. But
babies are not tested for HIV infection until about 6 weeks of age, meaning many infants are
unknowingly being given a vaccine that is dangerous for them.
Cotton said it might be possible to simply vaccinate children with BCG after it is known whether
they are HIV-infected.
"But once you interfere with a program and make it a bit complicated, it can have repercussions
as well, so it is a bit of a dilemma," he said.
The best result would be to have earlier diagnosis and treatment of HIV. Children infected with
HIV can be given an antibiotic, isoniazid, to prevent TB infection, Cotton said.
http://www.msnbc.msn.com/id/21601513/ 120 Philadelphia Inquirer Online
By CLARE NULLIS
strains.
against TB.
administration.
Department.
immune systems.
122 Delegates to Discuss Combatting TB, AIDS
By CLARE NULLIS
Wednesday, November 7, 2007; 8:15 PM
CAPE TOWN, South Africa -- Old drugs, outdated tests, empty promises, new threats. Such is the bleak
combination of TB and AIDS: an already nightmarish scenario worsened by the spread of virtually
untreatable strains.
and HIV _ which are still often treated separately, although they feed off each other. About one-third of
the world's 40 million people infected with the AIDS virus have TB, the vast majority of them in Africa. TB
kills more than 1.6 million people every year.
"Unlike bird flu, the global threat of HIV/TB is not hypothetical _ it is here now. But the science and
childhood. Antibiotics used to fight TB are more than 40 years old. Testing methods used in most
developing countries were developed 120 years ago, are notoriously slow and often fail to spot TB in
AIDS patients.
developing more effective drugs because TB primarily affects poor people in poor countries.
against TB.
the U.S. budget problems and overspending in Iraq, TB wasn't "even on the radar" of the U.S.
administration.
Department.
multidrug resistant TB and extensively drug-resistant TB, which was identified in 2006 and is now present
in more than 40 countries.
In South Africa, for instance, the cure rate for patients who stick to their treatment is just 50 percent, while
WHO's target is 85 percent. In some areas, it is as low as 30 percent, according to Greg Hussey, head of
the University of Cape Town's Institute for Infectious Diseases. People who are not properly cured are
prone to develop multidrug resistant TB, which requires a two year treatment regimen.
South Africa hit the headlines last year when an outbreak of HIV and extensively drug-resistant TB was
identified in 53 people at a clinic in Tugela Ferry in KwaZulu-Natal. All but one patient died within two
weeks.
have been infected with extensively drug-resistant TB. The majority of them die before they can be tested
or treated, according to Gilles van Cutsem, a project coordinator for Medecins Sans Frontieres in the poor
Cape Town suburb of Khayelitsha, one of the hardest hit areas.
have high HIV and TB rates but don't have proper surveillance or laboratory facilities.
© 2007 The Associated Press
124 VIETNAM
Online
Hôm nay là Thứ Ba, 27 Tháng Mười Một 2007
“Đại dịch kép” đe dọa châu Phi
Bệnh lao khá phổ biến tại nhiều khu vực nghèo ở vùng hạ Sahara châu Phi - Ảnh: AP
TTO - Số người mắc cả hai dịch bệnh HIV và lao phổi gia tăng đang tạo ra một “đại dịch kép” lây
lan khắp vùng hạ Sahara châu Phi như cảnh báo của các chuyên gia.
Theo Diễn đàn về nghiên cứu cộng tác điều trị HIV, hệ thống y tế địa phương không đủ khả năng
đối phó với đại dịch này. Tình hình càng thêm bi đát khi tỷ lệ bệnh nhân lao kháng thuốc ở nhiều
khu vực gia tăng cùng với sự lây lan của HIV.
Ông Veronica Miller, chủ tịch diễn đàn trên cho biết ½ trong số các trường hợp mắc bệnh lao mới
tại vùng hạ Sahara châu Phi hiện nhiễm HIV.
Khoảng 20% dân số thế giới mang vi khuẩn lao nhưng đa số không phát triển thành bệnh. Song,
tại nhiều khu ổ chuột ở châu Phi, bệnh lao lại khá phổ biến.
Ở một khu dân cư ở miền tây Cape, trẻ em có nguy cơ nhiễm lao cao gấp 100 lần so với trẻ sống
ở các nước phát triển. Trong khi đó, theo nhà nghiên cứu Stephen Lawn, các biện pháp xét
nghiệm hiện nay thường không phát hiện được lao, và chỉ “nhận diện” được nó khi đã quá trễ,
còn hệ thống y tế lại không đủ khả năng đối phó.
Ông cho biết nếu không được điều trị thích hợp, 90% bệnh nhân HIV sẽ tử vong chỉ trong vòng
vài tháng sau khi mắc bệnh lao.
T.VY (Theo BBC)
http://www.baomoi.com/Home/TheGioi/2007/11/1132374.epi?refer=www.tuoitre.com.vn/Tianyon/Index.as
px?ChannelID=2&ArticleID=227453 125