HIV/AIDS and its interaction with tuberculosis in Latin America and the Caribbean

ABSTRACT

At present, human immunodeficiency virus (HIV) is thought to have infected over 17 million people worldwide, over 1 million in North America and the Caribbean. By comparison, infection with the tuberculosis (TB) agent Mycobacterium tuberculosis is far more common, current estimates indicating that roughly one-third of the world's population is infected. These two infections tend to aggravate each other. That is, HIV leads to a progressive immune system depression that favors reactivation of TB in people with latent tuberculosis infections; it promotes progression of TB primary infections or reinfections to full-blown tuberculosis disease; and it fosters TB transmission, because those simultaneously infected with HIV and M. tuberculosis tend to develop a baciliferous and contagious TB that can be transmitted to other susceptible individuals, even though the latter are HIV-negative. In addition, this coinfection tends tok promote circulation of drug-resistant M. tuberculosis and to produce peculiar manifestations that complicate TB diagnosis, treatment, and control. Overall, it seems clear that the growing threat posed by these associated agents demands effective action in the form of well-coordinated measures involving thoroughgoing participation by all countries (AU)