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Epidemiology of HIV-associated tuberculosis

Lawn, Stephen Da,b; Churchyard, Gavinb,c,d

Current Opinion in HIV and AIDS: July 2009 - Volume 4 - Issue 4 - p 325–333
doi: 10.1097/COH.0b013e32832c7d61
Epidemiology: Edited by Tim Mastro and Quarraisha Abdool-Karim

Purpose of review We review literature concerning the epidemiology of HIV-associated tuberculosis (HIV-TB), focusing on articles published between 2007 and 2008.

Recent findings An estimated 1.37 million new cases of HIV-TB occurred in 2007, representing 15% of the total global burden of TB. In addition, an estimated 456 000 HIV-TB deaths accounted for 23% of global HIV/AIDS mortality. Sub-Saharan Africa is the worst affected region with 79% of the disease burden. The epicentre of the coepidemic lies in the south of the continent, with South Africa alone accounting for over one quarter of all cases. A critical overlap between HIV and the global multidrug-resistant TB epidemics is emerging. Although it is as yet unclear whether HIV is driving a disproportionate increase in multidrug-resistant TB cases at a population level, HIV has nevertheless been a potent risk factor for institutional outbreaks, especially in South Africa and eastern Europe. Increasing data have highlighted the risk of TB among HIV-infected healthcare workers in resource-limited settings. However, many studies also show the major benefits to be derived from antiretroviral therapy in high-income and low-income countries.

Summary HIV-TB remains a major challenge to global health that requires substantial increases in resource allocation and concerted international action.

aThe Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

bDepartment of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

cAurum Institute for Health Research, Johannesburg, South Africa

dNelson R. Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa

Correspondence to Stephen D. Lawn, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa Tel: +27 21 650 6957; fax: +27 21 650 6963; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.