Living with HIV - Dying of TB: CDC Accelerates TB prevention for People Living with HIV

“Today, we have TB preventive therapies that we know work and that can prevent the development of active TB disease. We must move quickly to expand access to these lifesaving treatments. And we must act now.”

– Hank Tomlinson, PhD

Acting Director of CDC’s Division of Global HIV & TB

TB and HIV are a deadly combination. In addition to being the top infectious disease killer in the world, TB is the #1 cause of death for people living with HIV (PLHIV), accounting for more than 30 percent of deaths among those living with HIV in 2017. Because of their weakened immune system, people living with HIV are both more likely to become infected with TB and more likely to develop active TB. In fact, people living with HIV are up to 21 times more likely to develop TB disease than someone without the virus.

The good news is that we have powerful treatment and prevention tools that can dramatically reduce these dire health outcomes.

Research shows that TB preventive treatment (TPT)pdf icon can reduce the risk of developing TB disease in people living with HIV. TPT reduces the number of patients who die in the 5 years after completing treatment by nearly 40 percent. When paired with ART, TPT can reduce the risk of death for those living with both diseases – by as much as 80 percent.

Yet, despite being proven effective and affordable, implementation of TPT around the world remains uneven and under-used, keeping this powerful treatment out of reach for millions who need it.

According to the World Health Organization (WHO), less than 20 percent of the 37 million people living with HIV have ever started TPT, despite WHO recommendations calling for expanded access since 1993. In 2016, only 1 million people living with HIV received TPT around the world. In that same year, nearly 400,000 people with HIV died from TB, a preventable and curable disease.

CDC Leading the Way to Accelerate Global TPT Uptake

In February 2018, WHO released new guidelines, calling for expanded TB testing and preventive treatment globally.  Recognizing the urgent need to accelerate the global response to these dual epidemics, CDC, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has launched a newly-intensified initiative aimed at scaling up TPT in countries with high burden of both TB and HIV.

Building on existing PEPFAR platforms around the world, CDC is working to aggressively scale up TPT to more people living with HIV. The agency is also developing and refining approaches to reach children who are eligible for the treatments as young children are up to ten times more likely to develop severe TB disease after infection and benefit greatly from TPT after exposure to TB.

“Today, we have preventive treatments that we know work and that can prevent the development of active TB disease,” said Hank Tomlinson, PhD, Acting Director of CDC’s Division of Global HIV & TB. “We must move quickly to expand access to these lifesaving treatments. And we must act now.”

As part of the new initiative, CDC is conducting baseline assessments among TPT programs in high burden countries – to identify gaps, determine best practices and replicate successful efforts worldwide. Using technical guidance, trainings, mentorship efforts and program innovations, CDC is helping countries rapidly expand life-saving TB preventive treatment to millions more people living with HIV. The goal is to triple the number of eligible people living with HIV starting TPT from 1 million in 2016 to nearly 3 million by 2019.

Immediately following the United Nations General Assembly High Level Meeting on September 26, the CDC Foundation and CDC also sponsored a side event – Preventing TB to End TB – focused on scaling up TB preventive treatment globally as a key strategy for achieving TB epidemic control and ultimately ending TB.  Co-hosted by colleagues at U.S. Agency for International Development, and U.S. National Institutes of Health, the event brought together global and public health leaders to discuss progress, challenges and future plans for implementation of TPT as part of comprehensive national and global TB programs.  Ultimately, more than 65 organizations and nation states from around the world committed to working more closely together to increase TB prevention, treatment, and cure efforts, as a result of this critical public health gathering convened by CDC and partners.

CDC’s Broader Efforts to Fight HIV and TB

This newly accelerated TPT initiative is just one component of CDC’s global work to align TB and HIV efforts – to accelerate progress against both diseases. In more than 30 high burden countries, CDC is working hand-in-hand with government partners, community groups, and health organizations to bolster access to ART.

CDC is also leading efforts to expand HIV testing for TB patients and intensify routine TB screening among those living with HIV. In 2017, CDC supported TB screenings for 4.7 million people with HIV, including 400,000 children and supported HIV treatment for 140,000 people living with both HIV and TB disease.

“Ending these epidemics demands that we, as a global community expand our efforts. TB preventive treatment is an effective, low cost, high-impact intervention that can save lives,” said Susan Maloney, MD, MPH, and Chief of the Global TB Branch in CDC’s Division of Global HIV & TB.  “Without action, we risk undermining the progress we’ve made against this deadly dual epidemic. With effective treatment, TB can be cured, HIV managed, and millions of lives saved.”

Read more about CDC’s efforts to find, cure and prevent TB around the world: