HIV and TB are a lethal combination.Although much progress has been made in tackling HIV, in 2015, there were over 36 million people living with HIV, and over 2 million people become newly infected with HIV each year. But there is ambition to end the HIV epidemic. Two years ago, the UNAIDS announced its 90-90-90 Initiative. By 2020, 90% of all people living with HIV will know their HIV status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART will have viral suppression.

We cannot end the HIV epidemic without tackling tuberculosis. TB is the leading cause of death among people living with HIV, accounting for one in five HIV-related deaths. Among major known risk factors for TB, HIV infection is the strongest; 12% of all new active TB cases and 25% of all TB-related deaths occur in HIV-positive individuals. The majority (75%) of HIV-associated active TB cases and deaths occur in Africa.

In many countries, HIV and TB care services are not well integrated, and individuals with HIV do not get screened for TB. In the same vein, persons with TB are not always tested for HIV. This needs to change, and all patients need quality, integrated, patient-centric TB and HIV care from the same center.

All individuals with HIV should be tested for TB using highly sensitive tools such as Xpert MTB/RIF, rather than smear microscopy (which can miss TB among people with HIV) [Image]. For individuals with HIV, ART access is critical, and will dramatically reduce the incidence of TB. ART has been demonstrated to reduce active TB incidence by providing immune reconstitution; the lower the CD4⁺ T cell count, the higher the ART-associated protection. The combined use of ART and isoniazid preventive treatment has also been shown to reduce active TB incidence and severe illnesses among HIV-positive individuals. The WHO recommends that all HIV-positive individuals with drug sensitive and drug-resistant active TB should also begin ART within the first 2 months of TB treatment, regardless of their CD4⁺ T cell count.

For more information on management of TB-HIV co-infection, please read our Nature Primer on tuberculosis at: http://rdcu.be/mTXZ