Tuberculosis epidemics driven by HIV: is prevention better than cure?

Objective: To compare the benefits of tuberculosis (TB) treatment with TB and HIV prevention for the control of TB in regions with high HIV prevalence. Design and methods: A compartmental difference equation model of TB and HIV has been developed and fitted to time series and other published data using Bayesian methods. The model is used to compare the effectiveness of TB chemotherapy with three strategies for prevention: highly active antiretroviral therapy (HAART), the treatment of latent TB infection (TLTI) and the reduction of HIV transmission. Results: Even where the prevalence of HIV infection is high, finding and curing active TB is the most effective way to minimize the number of TB cases and deaths over the next 10 years. HAART can be as effective, but only with very high levels of coverage and compliance. TLTI is comparatively ineffective over all time scales. Reducing HIV incidence is relatively ineffective in preventing TB and TB deaths over 10 years but is much more effective over 20 years. Conclusions: In countries where the spread of HIV has led to a substantial increase in the incidence of TB, TB control programmes should maintain a strong emphasis on the treatment of active TB. To ensure effective control of TB in the longer term, methods of TB prevention should be carried out in addition to, but not as a substitute for, treating active cases.

[1]  V. Springett.  Ten-year results during the introduction of chemotherapy for tuberculosis. , 1971, Tubercle.

[2]  O. Horwitz,et al.  Epidemiological basis of tuberculosis eradication. 10. Longitudinal studies on the risk of tuberculosis in the general population of a low-prevalence area. , 1969, Bulletin of the World Health Organization.

[3]  T. Kloek,et al.  Bayesian estimates of equation system parameters, An application of integration by Monte Carlo , 1976 .

[4]  J. Fitzgerald,et al.  An estimate of the future size of the tuberculosis problem in sub-Saharan Africa resulting from HIV infection. , 1992, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[5]  T. Quinn,et al.  HIV infection in patients with tuberculosis in Kinshasa, Zaire. , 1989, The American review of respiratory disease.

[6]  M C Weinstein,et al.  The cost effectiveness of combination antiretroviral therapy for HIV disease. , 2001, The New England journal of medicine.

[7]  G. J. Drolet,et al.  Present Trend of Case Fatality Rates in Tuberculosis. , 1938 .

[8]  B. Locke,et al.  Reactivation of inactive pulmonary tuberculosis. , 1956, American review of tuberculosis.

[9]  C. Lowe.  Recent Trends in Survival of Patients with Respiratory Tuberculosis , 1954, British journal of preventive & social medicine.

[10]  Interim proposal for a WHO Staging System for HIV infection and Disease. , 1990, Releve epidemiologique hebdomadaire.

[11]  John A. Nelder,et al.  A Simplex Method for Function Minimization , 1965, Comput. J..

[12]  B. Thompson.  Survival Rates in Pulmonary Tuberculosis , 1943, British medical journal.

[13]  A. Kamali,et al.  Two-year HIV-1-associated mortality in a Ugandan rural population , 1994, The Lancet.

[14]  Roel A. Coutinho,et al.  Time from HIV-1 seroconversion to Aids and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis: collaborative Group on Aids incubation and HIV survival including the CASCADE EU concerted action , 2000 .

[15]  E. Hershfield,et al.  Tuberculosis: a comprehensive international approach , 1993 .

[16]  K. Stýblo,et al.  Bacteriological and X-ray status of tuberculosis following primary infection acquired during adolescence or later. , 1977, Bulletin of the International Union against Tuberculosis.

[17]  Christopher Dye,et al.  Prospects for worldwide tuberculosis control under the WHO DOTS strategy , 1998, The Lancet.

[18]  M. Felten,et al.  Surveillance of resistance to antituberculosis drugs in developing countries. , 1994, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[19]  P. Piot,et al.  Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months. , 1995, The New England journal of medicine.

[20]  John L. Johnson,et al.  Duration of efficacy of treatment of latent tuberculosis infection in HIV-infected adults , 2001, AIDS.

[21]  S. Blower,et al.  Amplification Dynamics: Predicting the Effect of HIV on Tuberculosis Outbreaks , 2001, Journal of acquired immune deficiency syndromes.

[22]  J. Hammersley,et al.  Monte Carlo Methods , 1965 .

[23]  Kholoud Porter,et al.  Survival after introduction of HAART in people with known duration of HIV-1 infection , 2000, The Lancet.

[24]  P. Garner,et al.  Effect of preventive treatment for tuberculosis in adults infected with HIV: systematic review of randomised placebo controlled trials , 1998, BMJ.

[25]  D. Enarson,et al.  The fate of cases of pulmonary tuberculosis under various treatment programmes. , 1978 .

[26]  M. Lafontaine,et al.  Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast. , 1991, BMJ.

[27]  H. Gayle,et al.  Tuberculosis and HIV infection in children in Abidjan, Côte d'Ivoire. , 1994, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[28]  W. Tattersall.  The survival of sputum-positive consumptives; a study of 1,192 cases in a county borough between 1914 and 1940. , 1947, Tubercle.

[29]  K. McAdam,et al.  Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality. , 1992, The American review of respiratory disease.

[30]  Hiv Survival,et al.  Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis , 2000, The Lancet.

[31]  R. Hayes,et al.  The impact of HIV on infectiousness of pulmonary tuberculosis: a community study in Zambia. , 1993, AIDS.

[32]  M. Chan-yeung,et al.  Reactivation of inactive tuberculosis in Northern Canada. , 1971, The American review of respiratory disease.

[33]  D. Hom,et al.  Accelerated course of human immunodeficiency virus infection after tuberculosis. , 1995, American journal of respiratory and critical care medicine.

[34]  K. McAdam,et al.  The effect of human immunodeficiency virus type-1 on the infectiousness of tuberculosis. , 1994, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[35]  P. Godfrey-Faussett.  Policy statement on preventive therapy against tuberculosis in people living with HIV Author , 1999 .

[36]  Hadi Dowlatabadi,et al.  Sensitivity and Uncertainty Analysis of Complex Models of Disease Transmission: an HIV Model, as an Example , 1994 .

[37]  J. Witte,et al.  Transmission of Mycobacterium tuberculosis from tuberculosis patients with HIV infection or AIDS. , 1996, American journal of epidemiology.

[38]  K. Meeran.  Prevalence of HIV infection among patients with leprosy and tuberculosis in rural Zambia. , 1989, BMJ.

[39]  C. Mahé,et al.  Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study. , 2002, BMJ : British Medical Journal.

[40]  R. Brindle,et al.  Cohort study of HIV-positive and HIV-negative tuberculosis, Nairobi, Kenya: comparison of bacteriological results. , 1992, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[41]  P. Borcherds.  Importance sampling: an illustrative introduction , 2000 .

[42]  C. Murray,et al.  Modeling the impact of global tuberculosis control strategies. , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[43]  L. Harrison,et al.  Reduced risk of tuberculosis among Brazilian patients with advanced human immunodeficiency virus infection treated with highly active antiretroviral therapy. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[44]  Christopher Dye,et al.  The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. , 2003, Archives of internal medicine.

[45]  A. Reingold,et al.  Human immunodeficiency virus infection in children with tuberculosis in Santo Domingo, Dominican Republic: prevalence, clinical findings, and response to antituberculosis treatment. , 1996, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[46]  A Muñoz,et al.  Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. , 1998, JAMA.

[47]  R. Chaisson,et al.  Will DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection. , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[48]  De Cock Km,et al.  Will DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection. , 1999 .

[49]  M. Evans,et al.  Methods for Approximating Integrals in Statistics with Special Emphasis on Bayesian Integration Problems , 1995 .

[50]  P. Weidle,et al.  Assessment of a pilot antiretroviral drug therapy programme in Uganda: patients' response, survival, and drug resistance , 2002, The Lancet.