Though TB cases are declining in Japan, a surge in the number of HIV infections could lead to a rapid rise in dual TB-AIDS cases among vulnerable groups, doctors warned Monday at the 7th International Congress on AIDS in Asia and the Pacific in Kobe, Japan.

About 30,000 new TB cases annually are reported in Japan, but many more could go undetected among at-risk groups -- the poor, the homeless, low-income immigrants and youths -- who are unable or unwilling to seek medical help, said Dr. Nobukatsu Ishikawa of the Research Institute of Tuberculosis in Kiyose, Japan.

No data are available for the number of people TB-HIV co-infected in Japan. However, HIV-positive people are 50 times more likely to develop TB. Worldwide, one-third of those with HIV, or 14 million, are co-infected with TB.

Dr. Takashi Sawada, chairperson of the congress, said as many as 40 percent of the foreign HIV patients he treats are co-infected with TB. "Within an overall decrease, pockets of crises are emerging," said Ishikawa.

"When an ordinary person becomes infected with TB, they can usually be cured," said Ishikawa. "But if inappropriate treatment is administered [to someone also infected with HIV], it can result in multiple drug resistance, which in the worst case can be more frightening than AIDS," he said.

The TB threat in Japan has gone unnoticed, said Sawada and Ishikawa. TB funding is decreasing, and new health care changes could remove coverage for TB treatment from those likeliest to have the disease, said Sawada.

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