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Vol. 56. Issue 7.
Pages 446-454 (July 2020)
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Vol. 56. Issue 7.
Pages 446-454 (July 2020)
Review article
DOI: 10.1016/j.arbr.2019.11.013
Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out
Coinfección tuberculosis-VIH: avances y retos 2 décadas después de la implementación del tratamiento antirretroviral a nivel global
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Emilio Letanga,b,
Corresponding author
emili.letang@isglobal.org

Corresponding author.
, Jayne Ellisc,d, Kogieleum Naidooe,f, Esther C. Casasg, Paquita Sánchezb, Razia Hassan-Moosae,f, Fiona Cresswellc,h,i, Jose M. Mirój, Alberto L. García-Basteiroa,k
a ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
b Infectious Diseases Department, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
c Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
d Hospital for Tropical Diseases, University College London, London, UK
e Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
f MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
g Southern Africa Medical Unit, Médecins sans Frontières, Cape Town, South Africa
h Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
i MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
j Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
k Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
Article information
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Table 1. EndTB strategy pillars and components.
Abstract

Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.

Keywords:
Tuberculosis
HIV/AIDS
ART
Pathogenesis
Diagnosis
Treatment
Resource-limited settings
Implementation challenges
Resumen

A pesar de que el uso de antirretrovirales ha aumentado en uso y difusión durante las 2 últimas décadas, lo que ha resultado en la disminución de nuevas infecciones y de la mortalidad global, la tuberculosis asociada al VIH sigue siendo un importante problema de salud pública. La tuberculosis es la principal infección oportunista asociada al VIH y la principal causa de muerte a nivel mundial, particularmente en el marco de situaciones de recursos limitados. Existen varios retos con respecto al diagnóstico, la implementación global del tratamiento de la tuberculosis latente, el manejo de la tuberculosis activa, el proporcionar una prevención óptima de la tuberculosis y el VIH centrada en el paciente y la atención en países de alta carga. En este artículo revisamos los avances en la patogénesis, el diagnóstico y el tratamiento después de casi 2 décadas de implementación global de la terapia antirretroviral y comentamos los retos actuales para el control global de la coinfección tuberculosis-VIH.

Palabras clave:
Tuberculosis
VIH/SIDA
TARV
Patogénesis
Diagnóstico
Tratamiento
Situaciones de recursos limitados
Retos en implementación

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