Why has TB become a major cause of death with people who have HIV?

Tuberculosis (TB) is a leading cause of death among people living with HIV. According to the World Health Organization (WHO), TB is the leading cause of death among people with HIV, accounting for an estimated 300,000 deaths in 2020.

Several factors contribute to the increased risk and severity of TB in individuals with HIV:

1. Immunosuppression: HIV damages the immune system, making people with HIV more susceptible to developing TB. The weakened immune system is less able to fight off TB bacteria, allowing the infection to establish and spread more easily.

2. Co-infection: TB and HIV co-infection is common, and it worsens the prognosis of both diseases. HIV can accelerate the progression of TB and make it more difficult to treat. On the other hand, active TB can also increase the replication and progression of HIV, leading to a faster decline in immune function.

3. Delayed diagnosis: Co-infection with HIV can make TB diagnosis challenging. The symptoms of TB and HIV can overlap, leading to misdiagnosis or delayed diagnosis of TB in people with HIV. As a result, treatment may be delayed or initiated when the disease has already progressed to an advanced stage.

4. Treatment challenges: Treating TB in people with HIV can be complex due to potential drug interactions and adverse effects. Some drugs used to treat TB can interact with antiretroviral therapy (ART), which is used to treat HIV. Balancing the treatment regimens for both diseases can be challenging and may require close monitoring and adjustments to minimize drug interactions and adverse effects.

5. Social and economic factors: People with HIV and TB often face various social and economic vulnerabilities that can contribute to poor health outcomes. Barriers to accessing healthcare, lack of adequate nutrition, poor living conditions, and stigma associated with both diseases can further worsen the situation and increase the risk of severe TB disease.

Therefore, the combination of impaired immune function, co-infection, diagnostic challenges, treatment complexities, and social-economic factors contribute to the high mortality associated with TB in individuals with HIV. Comprehensive efforts are needed to improve early diagnosis, effective treatment, and support for people with HIV and TB co-infection to reduce the associated morbidity and mortality.