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Tuberculosis and HIV/AIDS must be tackled together if India is to meet the UN Millennium Development Goal of halving deaths from tuberculosis by 2015, say researchers.

In a paper published yesterday (5 July) in the Proceedings of the National Academy of Sciences, Chris Dye of the World Health Organization and colleagues warned that unless patients with both tuberculosis and HIV have access to drugs to treat both conditions, many could die.

Less than one per cent of Indian adults have HIV, but the country's large population size means that its total number of infected people — five million — is second only to South Africa.

Some scientists have suggested that this figure could increase to five per cent, which, most agree, could greatly increase the number of people dying from tuberculosis.

To investigate whether adequate tuberculosis control could counteract the threat of increased HIV in India, Dye's team created computer models for varying scenarios of HIV infection and tuberculosis control for the period 1990–2015.

In 1998, India began to implement its Revised National Tuberculosis Control Program, which included the WHO-recommended 'DOTS' strategy.

The researchers' models showed that if the programme had not been implemented, 33 per cent more HIV-positive people would die from tuberculosis by 2015. With the national control programme however, the models predict that deaths due to tuberculosis will drop by 39 per cent reduction, a result the researchers say is "reassuring".

The team calculates that the total number of Indians with HIV is unlikely to increase substantially between now and 2015.

But in areas of India where already more than one per cent of people are HIV-positive, deaths from tuberculosis will only fall by 15 per cent — even with the national tuberculosis control programme.

Ensuring that India meets the Millennium Development Goal of cutting the number of tuberculosis deaths in half by 2015 will need additional efforts, they say.

The team says tuberculosis patients should have access to HIV testing and to HIV drugs if they test positive. This will be especially important in regions of India, such as the area from Mumbai to Karnataka, where HIV prevalence is high.

Link to paper by Chris Dye and colleagues in Proceedings of the National Academy of Sciences

Reference: PNAS 102, 9619 (2005)

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