South African faces one of the worst dual epidemics of TB and HIV in the world, being ranked 2nd in terms of TB incidence (number of cases per capita) and 8th in terms of overall TB burden.
A person infected with TB has only a 10% lifetime risk of getting active disease because the immune system keeps the TB infection in check; however, if such a person becomes infected with HIV the risk for active TB increases to 10% per year because of immune suppression.
HIV not only increases the number of TB cases, but also alters the clinical course of TB disease. TB becomes more difficult to diagnose and can rapidly become fatal if not quickly diagnosed and treated.
Policies for voluntary HIV counseling and testing of TB patients have been introduced in South Africa recently; however, uptake of these policies has been slow, given the stigma around TB and HIV still prevailing in many communities.
Despite the fact that TB is curable (even when a patient is HIV-positive) many patients on TB treatment default from the 6-month regimen. The DOTS strategy for TB control has been shown to be highly successful in many parts of the world; however, South Africa is lagging behind with cure rates of less than 60%.
Premature stopping TB treatment leads to the development of multi-drug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB), which is extremely expensive and difficult to treat. Patients with MDR-TB, XDR-TB and HIV have a very high disk of dying. The two multi-drug resistant forms of TB can also easily be spread to HIV-infected individuals.
