Tuberculosis

Excerpt

A decade ago the problem of TB in Africa attracted little attention, not even meriting a chapter in the first edition of Disease and Mortality in Sub-Saharan Africa. Part of the reason was that TB incidence was low and falling in most parts of the continent (Cauthen, Pio, and ten Dam 2002). The burden of TB in Sub-Saharan Africa is far greater today. Continuing poverty and political instability in parts of the continent has inhibited progress in implementing effective TB control measures. But the principal reason for the resurgence of TB in Africa is not the deterioration of control programs. Rather, it is the link between TB and the human immunodeficiency virus and the acquired immune deficiency syndrome (HIV/AIDS). People who are latently infected with Mycobacterium tuberculosis—about one-third of the inhabitants of Sub-Saharan Africa (Dye et al. 1999)—are at hugely greater risk of developing active TB if they are also immunologically weakened by a concurrent HIV infection. HIV-positive people are also more likely to develop TB when newly infected or reinfected with M. tuberculosis. Over the past decade, the TB caseload has increased by a factor of five or more in those countries of eastern and southern Africa that are most affected by HIV. Incidence rates in these countries are now comparable with those recorded in Europe half a century ago, before the introduction of antituberculosis drugs.