World-Wide Challenges and Perspectives for Handling HIV/Mycobacterium tuberculosis Co-Infections

Abstract

(MTB). These pathogens induce the acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), two major communicable diseases with severe public health impact worldwide. Estimates of the World Health Organisation (WHO) and UNAIDS reveal a frightening prevalence: around 33 million individuals are infected with HIV and one third of the world’s population carries MTB. While both infections are representing global public health problems in their own right, their combination is particularly threatening due to considerable mutual interactions: In HIV-positive individuals infected by MTB, the risk to develop active TB is 21-37 times higher than that of the HIV-negative population [1]. As a consequence, TB has become the leading cause of mortality for people living with HIV/AIDS, even in regions where highly active antiretroviral therapy (ART) has been implemented, and HIV is the most potent force driving the TB epidemic in countries with a high prevalence of HIV infection. Currently, this “cursed duet” of AIDS/TB is exerting its detrimental effects in settings where HIV and MTB prevalence is highest (such as in Sub-Saharan Africa, India, Russia or Latin America) and where multidrug- (MDR) and extensively drug resistant TB (XDR-TB) are present [2-4]. In this context, the European Union financed a multi-national support action named “EUCO-Net” (http://www.euco-net.eu) after Robert Koch's discovery of the tubercle bacillus: the new