Despite gains in controlling tuberculosis in the region, the World Health Organization has warned that mortality due to the disease could spike if the deadly alliance between tuberculosis and HIV is not effectively countered.
A disease that preys on weakened immune systems, tuberculosis—which is spread through the air when an infected person sneezes, coughs or even speaks—is the leading killer of people infected with HIV.
“Gains in [tuberculosis treatment in] recent years may be undermined unless TB-HIV collaborative activities are put into place,” Shigeru Omi, WHO director for the Western Pacific region, said in a statement on Friday.
In Cambodia—which international WHO officials have praised for linking tuberculosis and HIV/AIDS programs—a report compiled in January showed that one tuberculosis patient out of 10 surveyed in the country was also infected with HIV.
Pratap Jayavanth, a WHO tuberculosis consultant in Phnom Penh, said health officials have identified four hot spots in Cambodia for co-infections with the two diseases. Those spots correspond to areas with a significant number of sex workers, Jayavanth said, adding that this plays a role in the co-infection.
More than 25 percent of the tuberculosis patients surveyed in Phnom Penh and Sihanoukville were HIV-positive, according to the survey. In Battambang province, the rate exceeded 20 percent, and in Banteay Meanchey 15 percent.
“HIV is driving the TB epidemic,” Jayavanth said Monday. “If the collaboration works between TB and HIV/AIDS programs, then we can really address these issues.”
The co-infection problem is a significant public health threat because, experts say, people living with HIV are as much as 50 times more likely to develop tuberculosis than those who are not HIV-positive.
Without proper treatment, approximately 90 percent of people infected with HIV die within months of contracting tuberculosis, according to a report released last year by the UNAIDS/Stop TB Partnership.
Numerous people in developing countries such as Cambodia get tuberculosis, which is curable with antibiotics, as the first manifestation of AIDS. The two diseases represent a deadly combination, since they are more destructive together than either disease alone, the report noted.
Health officials in Cambodia and around the world face the problem of only having old tools to battle tuberculosis. The diagnostic test for the airborne disease is nearly a century old, and the current vaccine has been in use for about 80 years.
However, Jayavanth said, there now are a number of promising diagnostic tools and tuberculosis treatment methods that are undergoing clinical trials worldwide.
“It takes time, but the WHO’s goal is that TB will not be a public health problem by the year 2050,” he said.
By 2010, in the meantime, WHO aims to cut the number of tuberculosis cases and tuberculosis deaths by half, compared to 1999. But tuberculosis and HIV co-infection are threatening to reverse the progress made towards this goal.
To keep the number of co-infection cases from increasing further, health workers are focusing on keeping tuberculosis outbreaks from exploding, and keeping HIV in check.
UNAIDS reports that Cambodia has the highest percentage of people infected with HIV in the region—roughly 2.6 percent—but that the country has made significant strides in controlling the epidemic.
Countries in the region such as Vietnam and Indonesia are now on the brink of widespread HIV epidemics, according to UNAIDS.
There are currently 7.4 million people living with HIV in East, South and Southeast Asia, compared to 25 million in sub-Saharan Africa, according to UNAIDS.
