The resurgence of tuberculosis

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) incidence declined for decades but has resurged in developed and developing nations.
• This resurgence is strongly linked to the spread of human immunodeficiency virus (HIV) infection.
• The emergence of multidrug-resistant (MDR) strains of Mycobacterium tuberculosis complicates treatment, especially in HIV-coinfected individuals.

Purpose of the Study:

• To highlight the public health challenge posed by the resurgence of tuberculosis.
• To emphasize the increased severity and mortality of MDR tuberculosis in HIV-infected patients.
• To identify incarcerated populations in New York State as a key group for intervention.

Main Methods:

• Review of tuberculosis incidence trends in the USA and Western countries.
• Analysis of the impact of HIV coinfection on MDR tuberculosis presentation and outcomes.
• Identification of incarcerated populations as a high-risk group for both TB and HIV.

Main Results:

• A halt in the decline and a subsequent resurgence of TB incidence since the mid-1980s in the USA.
• MDR tuberculosis in HIV-infected patients is often systemic, aggressive, and associated with high mortality.
• Incarcerated populations in New York State represent a significant 'at-risk' group for both TB and HIV.

Conclusions:

• The resurgence of tuberculosis, particularly MDR strains in HIV-coinfected individuals, presents a critical public health crisis.
• Intervention strategies targeting incarcerated populations are crucial for preventing and treating both TB and HIV.
• Effective public health programs are needed to address the complex interplay between HIV, MDR TB, and at-risk populations.