World AIDS Day
1 December 2020

To Meet HIV World Health Goals, TB Treatment Must be Maintained During COVID-19 Response

The global COVID-19 pandemic has strained health care systems around the world. In the developing world, tuberculosis (TB), which shares several symptoms with COVID-19, is often the first sign that a person has HIV. This World AIDS Day, the Forum of International Respiratory Societies (FIRS), of which the APSR is a founding member, is calling on governments, health advocates and non-government organisations to strengthen their response to AIDS and tuberculosis, and to ensure that TB services are maintained throughout their response to COVID-19.

TB is the leading cause of death among those with HIV/AIDS worldwide, accounting for about one in three deaths, according to the 2020 UNAIDS Global Update. Yet, 60 percent of people living with HIV and tuberculosis are unaware of their co-infection and therefore not receiving the care that could prevent serious illness and death, according to the World Health Organisation (WHO).

"Patients who are HIV positive remain at high risk for TB, and as the world directs its attention to addressing the COVID-19 pandemic, it is it critical that TB programmes continue to detect and treat cases," said Juan C Celedón, MD, DrPH, ATSF, President of the American Thoracic Society, a FIRS founding member. "When treated with preventative therapy, latent TB can be managed, reducing the chance of death from AIDS and TB by about 40 percent."

Shortly after AIDS emerged, it fuelled a global resurgence of TB that continues in many low- and middle-income countries. According to the Centers for Disease Control and Prevention, HIV infection is the strongest risk factor for progressing from latent to active TB.

COVID-19 presents another challenge, as the symptoms are similar to TB and patients can become ill with both diseases. According to the WHO, experience with COVID-19 infection in TB patients remains limited but people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. HIV also increases the risk of other infectious respiratory diseases, including Pneumocystis jiroveci pneumonia and bacterial pneumonia, both of which can be life threatening.

Since the AIDS epidemic began, the WHO estimates that 75.7 million people have become infected with HIV and 32.7 million people have died from AIDS-related illnesses.

Education, prevention strategies and new medicines, particularly antiretroviral therapies, have reduced the number of AIDS deaths by 60 percent per year since their global peak in 2004.

Still, UNAIDS estimates that in 2019, 38 million people were living with AIDS and about 1.7 million people became newly infected.

FIRS believes a global response to HIV/AIDS can be strengthened by:

• Increasing awareness of the continuing global threat of HIV-related disease and its link to TB and other respiratory diseases.
• Improving the health outcomes of people living with HIV through patient care and research into improved treatments and treatment strategies for both HIV and TB.
• Reducing the incidence and severity of HIV-related disease by strengthening mother-to-child transmission prevention programs and increasing the early use of antiretroviral therapy.
• Improving HIV education in at-risk communities to reduce the incidence of new HIV infections.
• Reducing HIV-related health disparities and inequities.

"As the global medical community responds to COVID-19, it must also continue to strengthen its response to HIV/AIDS, as well as TB prevention and treatment," said Dr. Celedón. "Not long ago, HIV/AIDS and TB seemed insurmountable, yet HIV/AIDS is now a manageable chronic illness thanks to antiretroviral therapies, and TB is preventable and curable if treated appropriately. As a result, the WHO has set a goal of ending the AIDS epidemic by 2030. The progress we have made against HIV/AIDS and TB should serve as an inspiration for medical systems dealing with COVID-19, as proof that epidemics can be managed."

World AIDS Day Fact Sheet 2020

AIDS: Progress, but Still a Major Global Killer

• In 2018, AIDS deaths were down more than half from 2004, when they peaked worldwide. However, the World Health Organization (WHO) still estimates that 690,000 people died from AIDS last year.
• According to the WHO, 38 million people were living with HIV and 1.7 million became newly infected in 2019. Approximately 7.1 million do not know they are HIV-positive.
• Around the globe, women make up 52 percent of those living with HIV, and in 2018, new infections among young women (aged 15–24 years) were 55 percent higher than among men of the same age, according to the Foundation for AIDS Research (amfAR).
• Over 60 percent of new HIV infections globally in 2019 were among key populations (men who have sex with men, people who inject drugs, sex workers, and transgender people) and their sexual partners, the WHO reports.
• Africa is the region of the world hardest hit by AIDS: 20.7 million Africans, not including those living in North Africa, are living with HIV. Young women are particularly affected. In sub-Saharan Africa, women aged 15-24 are twice as likely as men to be living with HIV, the WHO reports.
• HIV/AIDS is a problem around the world: 5.8 million people are living with HIV in Asia and the Pacific, 2.2 million in Western and Central Europe and North America, 2.1 million in Latin America, 330,000 in the Caribbean, and 240,000 in the Middle East and North Africa, UNAIDS estimates.
• Worldwide, 67 percent of those living with HIV are accessing antiretroviral therapy. Among pregnant women, 85 percent are accessing antiretroviral medicines to prevent transmission of HIV to their child, according to the WHO.
• In the United States, African Americans and Hispanics account for a disproportionate share of HIV diagnoses, 42 percent and 27 percent respectively in 2018, according to the Centers for Disease Control and Prevention.

AIDS, TB and Other Respiratory Diseases

• People with HIV are at increased risk of respiratory disease, including tuberculosis.
• TB is the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths worldwide, according to the WHO.
• The WHO reports that about half of those living with HIV and TB are unaware of their coinfection and therefore are not receiving care, which can reduce their chances of dying by around 40 percent.
• Shortly after it emerged, HIV/AIDS fuelled a global resurgence of TB that continues in many low- and middle-income countries. According to the CDC, HIV infection is the strongest risk factor for progressing from latent to active TB.
• Other infectious respiratory diseases are common in those with HIV, including pneumocystis jiroveci pneumonia (PCP) and bacterial pneumonia, both of which can be life threatening. Where antiretroviral therapy is widely available, noninfectious pulmonary diseases, such as COPD, pulmonary arterial hypertension, and lung cancer are often the cause of death in people with HIV.
• In the U.S., people with HIV are two to three times as likely to smoke as those who are HIV-negative, according to the CDC. Smoking compounds the challenges of treating infectious and non-infectious respiratory diseases in those with HIV.

The FIRS Response

The Forum of International Respiratory Societies (FIRS) calls on governments, health care programs, clinicians, public health specialists, and non-government organizations to strengthen their responses to HIV/AIDS by:

• Increasing awareness of the continuing global threat of HIV-related disease and its connection to TB and other respiratory diseases.
• Improving HIV education of at-risk communities to reduce the incidence of new HIV infections and decrease health disparities.
• Reducing the incidence and severity of HIV-related disease by strengthening mother-to-child transmission prevention programs and increasing the early use of antiretroviral therapy.
• Ending HIV-associated TB through TB infection control, preventive therapy, and widespread use of antiretroviral therapy.
• Adequately funding research into improved treatments for both HIV and TB.

About the Forum of International Respiratory Societies (FIRS)