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THE CURSED DUET TODAY: TUBERCULOSIS AND HIV-COINFECTION
Author
Affilliation
Barts health NHS Trust. Royal London hospital. Division of Infection. London, United Kingdom.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovações em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ. Brasil.
University of Brescia. Department of Infectious and Tropical Diseases. Brescia, Italy.
Barts Health NHS Trust. Royal London hospital. Department of Respiratory Medicine. London, United Kingdom.
Hospital Universitario de Monterrey. Centro de Investigación, Prevención yTratamiento de Infecciones Respiratorias., Monterrey, Nuevo León Mexico.
Universidade Federal do Rio de Janeiro. Instituto de Doenças do Tórax. Rio de Janeiro, RJ, Brasil.
Papworth Hospital NHS Foundation Trust. Department of Respiratory Medicine. Cambridge, United Kingdom.
Barts Health NHS Trust. Royal London hospital. HIV Medicine, Infection and Immunity. London, United Kingdom.
UCL Hospitals NHS Foundation Trust. University College London. NIHR Biomedical Research Centre. Division of Infection and Immunity. London, United Kingdom.
Galliera Hospital. Department of Infectious Diseases. Genoa, Italy.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovações em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ. Brasil.
University of Brescia. Department of Infectious and Tropical Diseases. Brescia, Italy.
Barts Health NHS Trust. Royal London hospital. Department of Respiratory Medicine. London, United Kingdom.
Hospital Universitario de Monterrey. Centro de Investigación, Prevención yTratamiento de Infecciones Respiratorias., Monterrey, Nuevo León Mexico.
Universidade Federal do Rio de Janeiro. Instituto de Doenças do Tórax. Rio de Janeiro, RJ, Brasil.
Papworth Hospital NHS Foundation Trust. Department of Respiratory Medicine. Cambridge, United Kingdom.
Barts Health NHS Trust. Royal London hospital. HIV Medicine, Infection and Immunity. London, United Kingdom.
UCL Hospitals NHS Foundation Trust. University College London. NIHR Biomedical Research Centre. Division of Infection and Immunity. London, United Kingdom.
Galliera Hospital. Department of Infectious Diseases. Genoa, Italy.
Abstract
The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.
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