title: The cursed duet today: Tuberculosis and HIV-coinfection.
abstract: The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.
authors.affiliation: Barts health NHS trust, Royal London hospital, division of infection, 80, Newark street, E1 2ES London, United Kingdom. Electronic address: simon.tiberi@bartshealth.nhs.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Tiberi
authors.affiliation: Oswaldo Cruz institute (IOC), laboratory of innovations in therapies, education and bioproducts, (LITEB), Fiocruz, Rio de Janeiro, Brazil. Electronic address: anna.carvalho@ioc.fiocruz.br.
authors.forename: Anna Cristina C
authors.initials: AC
authors.lastname: Carvalho
authors.affiliation: University of Brescia, university department of infectious and tropical diseases, World health organization collaborating centre for TB/HIV co-infection and TB elimination, Brescia, Italy. Electronic address: g.sulis@unibs.it.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Sulis
authors.affiliation: Barts Health NHS Trust, Royal London hospital, department of respiratory medicine, 80, Newark street, E1 2ES London, United Kingdom. Electronic address: devan.vaghela@bartshealth.nhs.uk.
authors.forename: Devan
authors.initials: D
authors.lastname: Vaghela
authors.affiliation: Hospital universitario de Monterrey, centro de investigación, prevención y tratamiento de infecciones respiratorias, Monterrey, Nuevo León UANL, Mexico. Electronic address: adrianrendon@hotmail.com.
authors.forename: Adrian
authors.initials: A
authors.lastname: Rendon
authors.affiliation: Federal university of Rio de Janeiro, instituto de Doenças do Tórax (IDT)/Clementino Fraga Filho hospital (CFFH), rua Professor Rodolpho Paulo Rocco, n° 255 - 1° Andar - Cidade Universitária - Ilha do Fundão, 21941-913, Rio De Janeiro, Brazil. Electronic address: fcqmello@idt.ufrj.br.
authors.forename: Fernanda C de Q
authors.initials: FC
authors.lastname: Mello
authors.affiliation: Papworth hospital NHS foundation trust, department of respiratory medicine, Papworth Everard, Cambridge, United Kingdom. Electronic address: anannarahman@nhs.net.
authors.forename: Ananna
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Barts Health NHS Trust, Royal London hospital, HIV medicine, infection and immunity, London, United Kingdom. Electronic address: Nashaba.Matin@bartshealth.nhs.uk.
authors.forename: Nashaba
authors.initials: N
authors.lastname: Matin
authors.affiliation: UCL hospitals NHS Foundation Trust, university college London, NIHR biomedical research centre, division of infection and immunity, London, United Kingdom. Electronic address: a.zumla@ucl.ac.uk.
authors.forename: Ali
authors.initials: A
authors.lastname: Zumla
authors.affiliation: Galliera hospital, department of infectious diseases, Genoa, Italy. Electronic address: pontals@yahoo.com.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pontali
mesh_terms: D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D001431:Bacteriological Techniques; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019468:Disease Management; D004197:Disease Reservoirs; D004347:Drug Interactions; D024901:Drug Resistance, Multiple, Bacterial; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000503:physiopathology / Q000628:therapy; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy; D008403:Mass Screening / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents