HIV: treating tuberculosis

Overview

HIV infection kills more people than any other infectious disease.[1] Infection with Mycobacterium tuberculosis is among the most important HIV-related opportunistic infections, in both resource-rich and resource-poor countries. The WHO estimates that tuberculosis is the cause of death in 13% of people who die from AIDS.[1] HIV infection compromises the host's immune defences and can lead to failure to control latent M tuberculosis infection, with the subsequent development of active (i.e., symptomatic) tuberculosis. The HIV pandemic has been a major contributing factor in the spread of tuberculosis in many countries. Tuberculosis most commonly affects the lungs, but can also affect many other organs, such as lymph nodes, kidneys, liver, GI tract, and the central nervous system. In a study of 132 HIV-positive people with tuberculosis in San Francisco, 50 (38%) had solely pulmonary disease, 40 (30%) had solely extrapulmonary disease, and 42 (32%) had both pulmonary and extrapulmonary disease.[2] In Africa and South America, 40% to 80% of HIV-positive people presenting with tuberculosis have pulmonary disease.[3] The specific symptoms of tuberculosis depend on the site of infection. Pulmonary disease characteristically presents with cough, haemoptysis, chest pain, and systemic symptoms, such as weight loss and night sweats. This review deals with the treatment of active tuberculosis (both pulmonary and extrapulmonary) in people with HIV. Prevention of tuberculosis in people with HIV is covered in a separate review (see review on HIV: prevention of opportunistic infections).

Latest citations

Isoniazid plus antiretroviral therapy to prevent tuberculosis: a randomised double-blind, placebo-controlled trial. ( 13 June 2014 )

Xpert(R) MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. ( 25 February 2014 )