This is in an effort to tackle the 230 000 deaths a year in people infected with both conditions.

The guidelines say that it is essential to increase the use of isoniazid as a preventive measure for tuberculosis and the use of antiretroviral drugs for HIV.

They also emphasise the need for collaboration and coordination of activities at all levels of operations, including planning, surveillance, delivery of services, and programme evaluation. The guidelines were released this week at the 17th international AIDS conference in Mexico City.

People with an immune system weakened by HIV are as many as 50 times more likely to develop tuberculosis in their lifetime than people who are not, and most people with HIV who become coinfected will die within a few months.

Kevin De Cock, WHO's director of HIV/AIDS, said there has been progress in better coordination between both activities, "but we are far from where we need to be. We are testing only about 35% of HIV patients for tuberculosis," he told a conference session the day before the guidelines were released.

He focused on the three areas in which activities needed to be increased, which he termed the three Is—intensified tuberculosis screening for signs of tuberculosis in patients with HIV; isoniazid prevention in people with latent tuberculosis infection; and infection control in crowded settings, such as medical facilities and barracks.

An activist from South Africa, speaking from the audience, noted that there was much uncertainty about the interventions for tuberculosis and for drug resistant tuberculosis, which had contributed to reduced enthusiasm for such advocacy.

Dr De Cock acknowledged the uncertainties but said that similar doubts about antiretroviral drugs existed before they were made widely available in those nations. It is a process where all parties will have to learn as they go along.

WHO guidelines are at www.stoptb.org/wg/tb_hiv

[10 Aug 2008 13:53]

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