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Overlapping Epidemics: TB, HIV and Viral Hepatitis

By Tracy Swan

April 2006

Disturbing reports of overlapping TB, HIV, and viral hepatitis epidemics emerged at the 2005 International AIDS Society Conference. In the newly independent states of Eastern Europe and Central Asia, HIV incidence continues to rise, and viral hepatitis is highly prevalent among prisoners, injection drug users, the homeless, and people in tuberculosis treatment programs.


HIV and Viral Hepatitis Among Prisoners, IDU, the Homeless and Persons in TB Treatment Programs
Population% TB% HIV% HBV & % HCV
People in TB treatment programs,
Republic of Georgia N=272
100%1.1%HBV: not reported
HCV: 22.4%
Injection drug users,
Republic of Georgia N=926
Not reported0.5%55% HBV
58.2% HCV
Prisoners,
Samara, Russia N=1334
100%12.2%HBV and/or HCV: 24.1%
Homeless adults & adolescents,
St. Petersburg, Russia N=312
not reported27.2%4.8% HBV
43.6% HCV


Hepatitis B and C are more easily transmitted through injection drug use than HIV. Disproportionate HBV/HCV and HIV prevalence rates among IDU in the Georgian Republic [55/58% v .5%; and 22.4% v 1.1%] reflect this reality. In regions where injection drug use is the primary mode of HIV transmission, an increase in new hepatitis B and/or C infections among high risk populations commonly precedes a spike in HIV incidence. If drug users in these regions are denied access to the information and apparatus necessary to prevent HIV -- sterile injection equipment, opiate substitution therapies, including methadone and buprenorphine, and available drug detoxification/treatment services -- they will continue to be needlessly infected.

Globally, tuberculosis is the leading cause of death among HIV-positive people. Poverty, incarceration, homelessness, and poor nutrition increase the risk for TB in populations where HIV and viral hepatitis are already endemic. Although TB is curable, co-infection with HIV complicates the diagnosis of TB and the treatment of both TB and HIV. Interactions between TB medications and antiretroviral agents restrict HIV treatment options. Additionally, certain drugs used to treat HIV and TB can cause hepatotoxicity. Coinfection with viral hepatitis increases the risk for antiretroviral-induced hepatotoxicity, and may, in turn, increase the risk for hepatotoxicity from TB therapy.

Tuberculosis can be cured. HIV and viral hepatitis can be prevented. When prevention is not possible, thorough screening, healthcare, and treatment services must be made available. Strategies to reduce the incidence and mortality of HIV, TB, and viral hepatitis in these regions will fail unless they consider the complex prevention, care and treatment needs of drug users and other groups vulnerable to this triple threat.

References available online.


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