16.2.1 Effect of HIV on tuberculosis
Ethiopia has one of the highest levels of TB/HIV co-infection in Africa. The WHO Global Report of 2008 estimates that in Ethiopia, 40% of TB patients tested for HIV were HIV-positive, while routine data from 1999 EFY (2006/7) estimates that as many as 31% of TB patients were co-infected with HIV.
Health workers should strongly recommend and routinely offer HIV testing to all TB patients and TB suspects, after providing adequate information on the benefits of such testing.
HIV increases the risk of infection with M. tuberculosis, and more importantly, increases the risk of progression to TB disease, and hence the incidence and prevalence of active TB. In addition, the HIV pandemic has led to an increase in the number of patients developing side-effects to anti-TB drug treatment. This has produced an increase in the workload for healthcare providers, which can compromise the quality of service and deplete resources. It has also been found that latent TB infection in HIV-positive persons reactivates at a rate of 10% per year, as opposed to 5–10% over a lifetime for HIV-negative persons. HIV-positive persons are prone to re-infection with new strains of TB from the community, and drug resistance may occur more frequently in TB/HIV co-infections.
16.2 TB/HIV co-infection