Special to The American
Although deaths among persons with both HIV and tuberculosis (TB) disease have decreased substantially since 1993, the CDC says continued efforts are critical to further reduce mortality. Persons with HIV are at increased risk for TB disease and death. To better understand the impact of HIV on the risk of death during treatment for TB disease in the U.S., researchers analyzed TB case data reported to CDC from 1993-2008; mortality analyses were restricted to data through 2006 to allow time for complete reporting. Overall, the proportion of TB patients who died during treatment declined from 18 percent in 1993 to 9 percent in 2006. Among TB patients with HIV, deaths declined from 41 percent to 20 percent, and the proportion of patients with HIV who were dead at the time of TB diagnosis declined from 7 percent to 4 percent. These declines correspond to an increase in HIV testing of TB patients and widespread availability of HIV antiretroviral therapies. Deaths did not decline among TB patients with unknown HIV status, suggesting many may have had undetected HIV. In 2008, HIV status was still unknown for 21 percent of patients; this despite recommendations stating that all TB patients should be tested for HIV. Researchers say HIV status is important to ensure appropriate treatment for TB patients, and more must be done to improve HIV and TB screening, initiate early treatment, and prevent TB among this population.