Tuberculosis and HIV co-infection—focus on the Asia-Pacific region

•The Asia-Pacific region, which contributes more than half of all tuberculosis (TB) cases worldwide, traditionally reports low TB/HIV co-infection rates, but this increased to 6.3% in 2013.•Routine testing of TB patients for HIV infection is not universally implemented, hampering accurate disease burden quantification and compromising patient care.•There is urgency to scale up interventions such as intensified TB case-finding, isoniazid preventive therapy, and TB infection control, as well as routine HIV testing and improved access to antiretroviral treatment.•TB recurrence is common in TB/HIV co-infected patients; relative rates of relapse and re-infection are dependent on the quality of care provided, prevalence of drug-resistant TB, and ongoing TB transmission within the community.•Increased awareness and concerted action is required to reduce TB/HIV co-infection rates in the Asia-Pacific region, especially among high-risk groups, and to improve the outcomes of people living with HIV.

SummaryTuberculosis (TB) is the leading opportunistic disease and cause of death in patients with HIV infection. In 2013 there were 1.1 million new TB/HIV co-infected cases globally, accounting for 12% of incident TB cases and 360 000 deaths. The Asia-Pacific region, which contributes more than a half of all TB cases worldwide, traditionally reports low TB/HIV co-infection rates. However, routine testing of TB patients for HIV infection is not universally implemented and the estimated prevalence of HIV in new TB cases increased to 6.3% in 2013. Although HIV infection rates have not seen the rapid rise observed in Sub-Saharan Africa, indications are that rates are increasing among specific high-risk groups. This paper reviews the risks of TB exposure and progression to disease, including the risk of TB recurrence, in this vulnerable population. There is urgency to scale up interventions such as intensified TB case-finding, isoniazid preventive therapy, and TB infection control, as well as HIV testing and improved access to antiretroviral treatment. Increased awareness and concerted action is required to reduce TB/HIV co-infection rates in the Asia-Pacific region and to improve the outcomes of people living with HIV.