Tuberculosis and HIV infection: How to decrease mortality?

Tuberculosis (TB) is still a real global scourge, with almost 10.6 million people still affected in 2021 and about 1.6 million having died from it, representing 4400 deaths per day worldwide. The most worrying co-morbidity in terms of public health remains co-infection with the human immunodeficiency virus (HIV). People living with HIV (PLWHA) account for 6.7% of TB cases and nearly 12% of deaths. This is particularly linked to the difficulties of both diagnosis and treatment of TB in PLWHA in low-and middle-resource countries. To reduce mortality associated with TB-HIV co-infection, it is essential to act on at least three levers: better prevention of the transition from latent TB infection to TB disease, better and earlier diagnosis of TB disease, and better management of both anti-TB and antiretroviral treatment (ART). Largescale development of TB chemoprophylaxis has accelerated since 2011. New diagnostic tools for TB have emerged over the past 15 years and have proven particularly useful for diagnosing smear-negative TB, including pulmonary TB in highly immunocompromised PLWHA and disseminated TB. Finally, early initiation of ART within 15 days of initiation of anti-TB drugs has been shown to be effective in reducing mortality in highly immunocompromised PLWHA. However, much more needs to be done to ultimately eradicate TB.(c) 2023 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.