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Wednesday, 10th of April 2013

• TUBERCULOSIS COMORBIDITY

 

The Lancet Infectious Diseases, Early Online Publication, 24 March 2013

 

Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts

Ben J Marais FCPaed a, Knut Lönnroth PhD b, Stephen D Lawn FRCP c d, Prof Giovanni Battista Migliori FRCPe, Peter Mwaba FRCP f g, Philippe Glaziou MD b, Matthew Bates PhD f w, Ruth Colagiuri GCHPM i, Prof Lynn Zijenah PhD h, Soumya Swaminathan MD j, Prof Ziad A Memish FRCP k l, Michel Pletschette FRCP m, ProfMichael Hoelscher FRCP n, Prof Ibrahim Abubakar FRCP p q, Rumina Hasan FRCPath o, Afia Zafar FRCPatho, Guiseppe Pantaleo PhD r, Gill Craig PhD s, Peter Kim MD t, Prof Markus Maeurer FRCP u, Marco Schito PhDv, Prof Alimuddin Zumla FRCP f w

Summary below; full text is at

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2813%2970015-X/fulltext

Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.

a Sydney Emerging Infections and Biosecurity Institute, and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia

b Stop TB Department, WHO, Geneva, Switzerland

c Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

d Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

e WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy

f University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka, Zambia

g Ministry of Health, Lusaka, Zambia

h University of Zimbabwe College of Health Sciences, Harare, Zimbabwe

i Health and Sustainability Unit at Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia

j National Institute for Research in Tuberculosis, Chennai, India

k Ministry of Health, Riyadh, Saudi Arabia

l College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

m Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland

n Department for Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich, Munich, Germany

o Department of Microbiology and Pathology, Aga Khan University Hospital, Karachi, Pakistan

p Health Protection Agency, London, UK

q Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, London, UK

r Division of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

s School of Health Sciences, City University London, London, UK

t Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

u Division of Therapeutic Immunology, LabMed, and Microbiology, Tumor and Cell Biology, Karolinska Institute and Center for Allogeneic Stem Cell Transplantation, Karolinska Hospital, Stockholm, Sweden

v Henry M Jackson Foundation-Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

w Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK

Correspondence to: Prof Alimuddin Zumla, Centre for Clinical Microbiology, University College London, Royal Free Hospital, London NW3 2PF, UK