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Spread of Tuberculosis Seen Slowing Progress on AIDS

Inadequate attention to the spread of tuberculosis is undermining recent gains made against the virus that causes AIDS, United Nations officials said Monday.

Tuberculosis and AIDS are now epidemic in many areas of the world, and the two infectious diseases must be addressed together, said the officials, who spoke from the United Nations’ first high-level meeting on the interaction of the two diseases.

Tuberculosis, an airborne disease, is the most important medical complication of infection with H.I.V., the virus that causes AIDS. Tuberculosis is also the No. 1 killer among H.I.V.-infected people in Africa and a leading cause of their death elsewhere, the officials said.

Jorge Sampaio, a former president of Portugal who serves as the United Nations’ special envoy to stop tuberculosis, said he and Secretary General Ban Ki-moon had convened the meeting at the United Nations headquarters to gain political support for “a much-neglected problem.”

In addition, the officials said, because of the continued spread of drug-resistant tuberculosis, health workers may become increasingly reluctant to care for H.I.V.-infected patients.

Dr. Kevin M. DeCock, director of the H.I.V. department of the World Health Organization, a United Nations agency, said that health workers might accept the modest risk of becoming H.I.V.-infected through needles and blood. But, he added, “it is quite another thing if you are at risk by sharing air with patients with H.I.V. disease” who have tuberculosis that is resistant to standard and second-line drugs.

That, he said, “has the potential to change how health care workers look at the issue of AIDS care.”

Because tuberculosis is often neglected, people who are infected but have no symptoms often fail to receive a drug, isoniazid, that could help prevent development of the full-blown disease, the officials said.

At least 700,000 tuberculosis cases develop among H.I.V.-infected people each year, and this year an estimated 230,000 H.I.V.-infected people will die from tuberculosis. The number includes many who received standard antiretroviral drugs that can keep H.I.V. in check, but failed to receive drugs that can usually cure nonresistant tuberculosis, said Dr. Mario C. Raviglione, the director of tuberculosis control for the W.H.O.

Nearly 1,000 cases of the most drug-resistant form of tuberculosis have been detected throughout South Africa. Additional cases have been found to varying extents in other countries throughout the world.

Dr. DeCock likened the current situation in southern Africa to the recognition of drug-resistant tuberculosis in New York City and parts of Florida in the late 1980s and early 1990s.

All forms of tuberculosis can be transmitted to anyone, whether H.I.V.-infected or not, and can spread locally, regionally and elsewhere by air travel, Dr. DeCock said.

The dangers of transmission of resistant tuberculosis came to widespread attention at the International AIDS Conference in Toronto in 2006. There, researchers reported a recent outbreak in which 52 of 53 patients in a rural hospital in South Africa had died from the most resistant form of the disease.

Treatment of drug-resistant tuberculosis is difficult and costly. Some patients can be treated successfully by manipulating combinations of drugs after extensive laboratory tests of the bacteria that infected them. But such tests are generally available only in rich countries.

A particular problem is that in 2006 worldwide, only 12 percent of reported tuberculosis cases were also tested for H.I.V.; in Africa the percentage was 22. But Dr. Raviglione noted a few signs of progress. He said that the percentage of tuberculosis patients tested for H.I.V. in Kenya rose to 70 in 2007 from 19 in 2004 and in Malawi to 83 from 25 in 2004. In Rwanda, the percentage rose to 89 from zero.

Dr. Raviglione and others called for strengthening the health infrastructure in many countries to detect additional cases. He also called for more research because standard tools and drugs are difficult to use in poor countries.

An investment of $19 billion through 2014 could cut deaths by 80 percent, the officials said.

Mr. Sampaio, the United Nations special envoy, said the “call for action” represented “the next inevitable step if we really want to control these two epidemics, because if we don’t do it, the economic, social and human rights situation will be much worse than it is today.”

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