HIV and other infections

European framework to decrease the burden of tuberculosis (TB) and HIV coinfection

TB and HIV/AIDS are global public health problems with considerable mutual interaction. Globally, TB is a leading killer of people living with HIV/AIDS (PLWHA). In high-prevalence countries, HIV is the most potent driver of the TB epidemic. While TB incidence is declining in central and western countries in the WHO European Region, a high burden persists in the eastern countries. TB/HIV morbidity and mortality are expected to accelerate significantly in the Region.

In recognition of the close interaction of the TB and HIV epidemics, the global Stop TB Partnership established the TB/HIV Working Group in 2001 to coordinate and promote interventions to decrease the burden of HIV-related TB (TB/HIV). The Working Group developed a global TB/HIV strategic framework, as well as implementation guidelines for adaptation in each WHO region.

In 2002, the WHO Regional Committee for Europe urged Member States to develop comprehensive, multisectoral, national HIV/AIDS strategic plans and programmes and to promote effective collaboration between TB and HIV prevention and control programmes.

WHO/Europe recently developed the European framework to decrease the burden of TB/HIV as the result of an extensive consultation process with those responsible for national HIV/AIDS and TB programmes and their partners.

The framework aims to guide countries in the Region in developing their national plans to reduce TB/HIV morbidity and mortality. It builds on strategies developed globally and in Europe for TB control and for HIV/AIDS prevention and care. It sets out the rationale for effective action to address TB/HIV, including the collaboration between national programmes for TB and HIV/AIDS. It identifies the populations at risk of TB and HIV, five strategic components and eight key operations. The main target audience comprises policy-makers in ministries (particularly health, justice and interior ministries), international agencies and nongovernmental organizations.

HIV and hepatitis coinfection

HIV epidemics in many European countries are driven by injecting drug users (IDU) or men who have sex with men (MSM). These populations also report a high prevalence of HIV/hepatitis coinfection due to the same mode of transmission of two viruses. In the absence of hepatitis treatment, mortality in people living with HIV/AIDS increases.

Liver cirrhosis and hepatocellular cancer due to hepatitis are among the top reasons of death among people living with HIV/AIDS.

The prevalence of hepatitis C virus infection in HIV-infected patients is particularly high in Europe and still rising, in contrast to the rest of the world, averaging 40% and reaching 50–90% in urban areas. Yet only a minority of HCV/HIV-coinfected patients are treated for hepatitis. Hepatitis B infection is more frequent and more severe in HIV-infected people and hepatitis D is also often found in patients with HCV, most commonly in IDU, and causes more severe liver disease than hepatitis B alone.