Tuberculosis and HIV disease: two decades of a dual epidemic.

The HIV epidemic is currently in its third decade without any sign of abating. Tuberculosis (TB) is responsible for a third of all AIDS deaths, 99% of which occur in developing countries. The two epidemics fuel each other, together making up the leading infectious causes of mortality worldwide. Tuberculosis-HIV coinfection presents special diagnostic and therapeutic challenges and constitutes an immense burden on the health care systems of heavily infected countries. Despite major gains that have been made in the past two decades, important questions still remain. To cope with the challenge of TB-HIV coinfection, further research in the design of diagnostic tests for tuberculosis, detection of drug resistant Mycobacterium tuberculosis strains in HIV-positive people, as well as development of more effective therapeutic agents and vaccines are urgently needed. It has become evident that this dual epidemic will persist unless comprehensive measures are instituted through the provision of sufficient funding in addition to expanding and strengthening current control strategies adopted by governments and international organizations.