TB-HIV Co-Infection

"We cannot win the battle against AIDS if we do not also fight TB." - Nelson Mandela

Disease Burden[1]

  • TB is the leading killer of people with HIV/AIDS. One in four deaths among people with HIV is due to TB.
  • Unlike HIV/AIDS, TB is completely curable in the vast majority of cases, with medicines that cost as little as $20, as long as treatment regimens are monitored and completed in order to avoid building up of drug resistance.
  • Of the 9 million people who develop TB each year, one in ten is HIV positive, resulting in 1.1 million new TB cases among people living with HIV. Approximately 82% of TB-HIV co-infection occurs in sub-Saharan Africa.
  • Globally, one-third of the 34 million people living with HIV is infected with TB.
  • People living with HIV and TB are up to 34 times more likely to develop active TB then people without HIV.  It is crucial that people living with HIV gain early access to antiretroviral treatment (ART), which helps prevent the development of active TB.  
  • In 2010, only 34% of TB patients were tested for HIV.  In Africa, which has the highest burden of TB-HIV, 59% of TB patients are tested for HIV.
  • The number of people living with HIV who were screened for TB went from 600,000 in 2007 to 2.3 million in 2010, but still accounts for less than 7% of the 34 million people living with HIV globally.
  • People living with HIV need early diagnosis and treatment of active TB. If active TB is not present, the patient should be put on isoniazid preventive therapy (IPT), which prevents active TB from developing. Among the 1.5 million people newly enrolled in HIV care in 2010, only 12% were given IPT.

The Critical Importance of TB-HIV Coordination

  • If left untreated, TB can kill a person with HIV/AIDS in a matter of weeks. With ART and TB treatment, life can be extended by years.
  • Providing routine HIV testing and counseling to TB patients and rapid enrollment in care is one of the most effective means of ensuring people living with HIV have access to treatment for both diseases.
  • People living with HIV/AIDS should be screened for signs and symptoms of TB at each visit to a health center.
  • All health facilities should take measures to control the spread of airborne disease, such as providing ventilation and providing masks to patients who are coughing.
  • TB and HIV programs should work together and ideally placed in the same location. All people living with HIV should be tested for TB and all people with active TB should be tested for HIV.  Historically, these services have been provided separately, with many patients lost in the process, but some countries, such as South Africa, Kenya and Rwanda, are making huge gains by integrating services.

Drug-Resistant TB Threatens Progress in the Fight Against HIV/AIDS

  • Extensively drug-resistant tuberculosis (XDR-TB) is resistant to not only the most effective first-line drugs, but also to critical second-line drugs. In some sampled populations, fatality rates approach 100%.
  • XDR-TB threatens to reverse progress made against HIV/AIDS. In the first reported outbreak of XDR-TB patients, in KwaZulu-Natal Province, South Africa, 52 of 53 patients with XDR-TB died. Of the 43 patients tested for HIV, all were positive.
  • XDR-TB has now been found in over 69 countries and there are an estimated 25,000 new cases each year;[2] however it is likely to be under-reported, as very few endemic countries have the laboratory capacity to test for drug resistance.

New Tools are Drastically Needed to Address TB-HIV Co-infection

  • New drugs are needed that are safe and effective for people co-infected with TB and HIV. The standard therapy for TB relies on drugs that are over 40 years old and which in some cases cannot be taken with antiretroviral therapy for HIV.
  • HIV significantly increases the chance that a person with TB will have a sputum-smear negative form of the disease, which is impossible to detect using the standard microscopic diagnostic tool.
  • Laboratory capacity must be scaled up throughout developing countries so that TB can be quickly and accurately detected.
  • A new diagnostic, Xpert MTB/RIF, quickly and accurately diagnoses TB among PLHA. Resources are urgently needed to make Xpert MTB/RIF available worldwide.

Addressing TB-HIV is a key component of the Stop TB Partnership's Global Plan to Stop TB 2011-2015, underpinned by the World Health Organization's Stop TB Strategy, which presents a detailed and feasible road map to save at least 5 million lives.

For more information on WHO’s collaborative TB/HIV policies, see here.


[1] World Health Organization. (2011). TB/HIV Facts 2011 [fact sheet]. Geneva, World Health Organization.

[2] World Health Organization. (2011). Tuberculosis MDR-TB & XDR-TB Progress Report [fact sheet]. Geneva, World Health Organization.