Guest Editorial

HIV/TB

Linda-Gail Bekker, MB ChB, DTMH, DCH, FCP (SA), PhD

The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town

Linda-Gail Bekker is the Deputy Director of the Desmond Tutu HIV Centre and Chief Operating Officer of the Desmond Tutu HIV Foundation. She has a keen interest in the prevention and treatment of HIV and tuberculosis in South Africa.

Gary Maartens, MMed, FCP (SA), DTM&H

Professor of Clinical Pharmacology and Chief Specialist, Department of Medicine, University of Cape Town

Gary Maartens is a practising physician. His main research interests are on clinical aspects of HIV and tuberculosis.

Correspondence to: Linda-Gail.Bekker@hiv-research.org.za

South African reports to the World Health Organization (WHO) indicate that its tuberculosis (TB) notifications have increased fivefold over the last 20 years; in 2008, South Africa had the third-highest TB burden, after India and China. South Africa and Swaziland now have the highest TB notification rates in the world, with about 1% of their populations developing TB annually. South Africa also has the greatest number of HIV-infected individuals in any country in the world, estimated at 5.5 million. South Africa was responsible for approximately 25% of the global burden of HIV-associated TB cases in 2007.

Furthermore, the South African national TB control programme has become an increasingly important pathway to HIV care and access to antiretroviral therapy (ART). Given the synergistic epidemics of HIV and TB in southern Africa, the question of how and when to integrate HIV and TB treatment in co-infected patients is a critical one. This edition of CME is therefore devoted to the patient, adult and paediatric, who presents to your services with both diseases – raising issues of :

• When to start ART in cases of TB

• What drug interactions can be expected?

• When and how will immune reconstitution manifest?

• What if the TB is drug resistant?

• And, on a programmatic level, how severe is the problem?

• How best to find the cases? and

• How to make the diagnosis?

We hope this bumper edition will answer many of the questions you face daily in managing what has become a far too common patient presentation.

October 2011 Vol.29 No.10 CME 397