Rise of HIV Threatens Success of TB Programs in Russia

A sharp rise in the number of Russians infected with HIV could cause a " tuberculosis epidemic" in the country, researchers write in the Nov. 3 issue of the Lancet. Reuters reports that approximately 16 million Russians, or 17% of the population, are infected with TB (Reuters, 11/2). Dr. Boris Kazionny of the Orel oblast Central Tuberculosis Dispensary and colleagues charted the spread of HIV and TB in Orel oblast, an area in Russia that is the site of a World Health Organization project for TB control. In 1999, Orel oblast recorded 72 TB infections per 100,000 people, with 3.7% of new infections classified as drug resistant. WHO, along with American and Russian health officials, in 1999 implemented in the region a TB control program of directly observed treatment, short-course (DOTS), in which patients are watched by a health care worker while they take their medicines. The scientists write that although the DOTS project has proved "highly promising" -- 81% of newly diagnosed patients successfully completed treatment -- there has been a "rapid increase" of HIV infection in the area. Between 1997 and 2001, HIV infection has increased 33-fold in the area, "raising serious concerns about the effects of the virus on burden of TB and multidrug-resistant TB and on the future effectiveness of DOTS," the researchers write. They add that the factors that have contributed to the spread of TB in Orel and the former Soviet Union -- poverty, unemployment, substance abuse, intravenous drug use and declining resources for public health -- are similar to those that have contributed to the rise of HIV in the region. The scientists also note a "substantial overlap" between populations with TB and those at risk of HIV infection, which could lead to an increase in the number of people infected with both diseases. "If spread of HIV is not prevented, coinfection will accelerate the resurgence of TB. Furthermore, the potential for massive TB spread in HIV-infected individuals in settings such as prisons -- in which rates of TB and multidrug-resistant TB are the highest -- is especially alarming," the researchers state.

Slowing HIV and TB
Fighting the spread of HIV in Russia will require better surveillance, "extensive" public health education, more awareness campaigns, specialized prevention outreach, risk reduction counseling and prevention initiatives directed at high risk populations, the researchers state. Additional measures will be needed to halt the spread of HIV-related TB, especially drug-resistant TB, including "rapid and widespread" implementation of DOTS throughout Russia and the creation of programs to treat drug-resistant TB that focus on "rapid" testing and the "appropriate use of second-line TB drugs." In addition, Russia must draft "well-founded guidelines" for TB treatment in patients coinfected with HIV (Kazionny et al., Lancet, 11/3).