Managing tuberculosis and HIV in sub-Sahara Africa.

Tuberculosis (TB) and HIV represent a deadly duo in sub-Sahara Africa, a region most affected by both diseases. The HIV epidemic has aggravated already strained and frequently poorly performing TB control programs. These programs face numerous challenges, and novel, regionally appropriate solutions need to be developed. In the context of TB, some challenges include the rapid diagnosis of active TB in the face of paucibacillary lung disease and atypical presentations with HIV/AIDS, lack of clinical expertise, poor contact tracing, limited laboratory facilities, delayed recognition of drug-resistant TB, increased workload of health care workers, erratic drug supplies, inadequate isolation facilities, and environmental and personal protection in drug-resistant cases. Similar problems exist in the context of HIV but are aggravated by the need for complex antiretroviral drug regimens and lifelong treatment. Treating both conditions invites drug interactions and toxic effects that are common to both HIV and TB treatment and the vexing question of when to introduce antiretroviral treatment in subjects with active TB. Combining HIV and TB care has the potential to bring additional infrastructural and human resources to the respective programs, with synergistic benefits.