TB is the leading infectious killer of people living with HIV, and accounts for an estimated 13% of AIDS deaths worldwide. HIV and TB are so closely connected that they are often referred to as co-epidemics or dual epidemics. The epidemics drive and reinforce one another: HIV activates dormant TB in a person, who then becomes infectious and able to spread the TB bacillus to others.

Untreated, someone with active tuberculosis will infect an estimated 10 to 15 people per year. The Stop TB Strategy is the internationally recommended standard for preventing, diagnosing and treating TB and includes recommendations for managing TB in people living with HIV. Recently a new TB strain, extensively drug resistant TB (XDR TB), has emerged, which is particularly dangerous for people living with HIV in whom it is frequently fatal. Preventing the development and spread of drug resistant TB through greater investment in TB services, improved community case finding and adherence support, and more effective infection control are essential.

To appropriately respond to both epidemics and avoid more widespread drug resistance, care and prevention of both diseases should be priority concerns of all TB and HIV programmes. UNAIDS, the Stop TB Partnership and the World Health Organization (WHO) are together encouraging a concerted, coordinated global effort to control TB in people living with HIV. In addition, the Stop TB Partnership has formed the TB/HIV Working Group, which develops global policy on the control of HIV-related TB and advises on how those fighting against TB and HIV can work together.

These partnerships have led to the creation of policies and guidelines to deal with HIV-related TB, and countries and organizations have taken important steps towards integrating their HIV and TB responses. However, more collaborative action is needed to widely implement programmes, including those that:

• Offer HIV testing and counselling to all TB patients
• Screen all people living with HIV for TB disease
• Provide TB treatment or preventive therapy to all co-infected people
• Provide cotrimoxazole and antiretroviral treatment to all TB patients with HIV
• Ensure TB infection control in all health care facilities and high HIV prevalence settings

Workplaces are important and valuable venues for an integrated HIV and TB response. Maintaining productivity benefits companies, enhances the lives of workers and their families, and mitigates the effects of the HIV epidemic on the community. Specific interventions in the workplace can include TB prevention programmes, DOTS for workers receiving treatment, HIV counselling and testing programmes, and links to or onsite care and support programmes for workers with TB and HIV.

http://www.unaids.org/en/PolicyAndPractice/HIVTreatment/Coinfection/TB/default.asp