As Tuberculosis Cases Decline in Europe, HIV/TB Coinfections Rise

Although the rate of new tuberculosis (TB) cases has decreased in areas across Europe, new data show that TB and HIV coinfections have increased by 40% from 2011 to 2015.

The data were released by the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe. It showed that new TB cases and deaths in the 53 countries of the WHO European Region declined each year by 4.3% and 8.5%, respectively, between 2011 and 2015.

Vulnerable groups such as individuals living with HIV, prisoners, and migrants did not benefit from this trend. Unfortunately, TB is the leading cause of death among individuals with HIV. Over the last 5 years TB and HIV coinfection increased significantly from 5.5% to 9% in the WHO European Region.

“The flare-up of TB/HIV coinfections from 2011 to 2015, together with persistently higher rates of drug-resistant tuberculosis, seriously threaten progress towards ending TB, the goal that European and world leaders have committed to achieve by 2030,” said Dr Zsuzsanna Jakab, WHO regional director for Europe. “One in 3 people coinfected with TB/HIV do not know about their status, which drastically lowers their chance of being cure. In turn, this favors the spread of the diseases, putting health systems and governments under pressure.”

In 2015, there was an estimated 27,000 new TB/HIV patients in the area, with only about two-thirds who were diagnosed and 5800 who started antiretroviral therapy, approximately 40% of which were successfully treated.

Individuals with TB/HIV coinfection have a 7 times higher risk of failing treatment and a 3 times higher risk of dying compared with individuals with only TB.

“The European Commission is committed to mobilizing all available tools to help EU countries meet the global commitments made in international for a within the given deadlines,” said Vytenis Andriukaitis, European commissioner for health and food safety. “TB affects the most vulnerable members of societies and often coexists with other conditions such as HIV or viral hepatitis.”

New TB cases in the European Union and European Economic Area (EU/EEA) were similar to those in the WHO European Region, with rates consistently decreasing since 2002. However, the annual decrease in the EU/EEA is only 5% and they would need an annual decrease of at least 10% to meet the set target to end TB.

“The general downward trend in reported TB cases is encouraging, but some groups are not benefitting from this trend and we need to target our efforts better if we want to end the TB epidemic,” said Dr Andrea Ammon, ECDC acting director. “Looking at the data for the EU/EEA, we see that the TB treatment success rate of coinfected patients is below the global target of 85%. But although we know about the challenges of TB/HIV coinfection, for 2 out of 3 TB patients the essential information on their HIV status was not reported in 2015. We need to get better at this.”

Although the EU/EEA may not reach its goal to end TB, they have seen a decline in reported TB/HIV coinfections from approximately 6% in 2011 to 4.6% in 2015. However, the authors noted that only 19 EU/EEA countries reported data on the coinfection status in 2015 and this information as known for only 1 of 3 patients with TB in the EU/EEA.

The WHO’s regional TB action plan for 2016-2020 and the policy on collaborative TB/HIV coinfection strongly recommended that European countries systematically provide HIV testing and counseling to all patients with TB, and vice versa.

Following a diagnosis, patients should receive immediate antiretroviral treatment and receive support through integrated and person-centered TB/HIV health services.

A vital part of achieving this objective is to obtain information on the burden of TB/HIV coinfection, including evidence of TB/HIV coinfection in groups at a higher risk. A major challenge for EU/EEA countries to reach the TB elimination target in the coming years is that notification of TB cases in the area is decreasing at a slower pace among residents of foreign origin (4%) compared with native residents (7%).

Targeted interventions for early detection and universal access to free of charge treatment and care will be crucial.