HIV-Associated Tuberculosis

Abstract

Key Points

HIV-Associated Tuberculosis

Almost half of inpatients with human immunodeficiency virus (HIV)–associated tuberculosis in countries with a high disease burden of HIV and tuberculosis have mycobacteremia, and features of sepsis are commonly present.

Tuberculosis can be diagnosed rapidly with the use of molecular tests (e.g., the Xpert MTB/RIF assay) in sputum and a LAM assay in urine, which together detect more than two thirds of cases in unselected inpatients with HIV infection. Empirical tuberculosis treatment based on clinical and radiographic features is often needed in cases of severe illness, pending the results of mycobacterial cultures.

Initiation of antiretroviral therapy in patients being treated for tuberculosis can cause the paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome, manifested as new, recurrent, or worsening symptoms and signs of tuberculosis. The syndrome can be managed or prevented with glucocorticoids.

Isoniazid therapy and newer regimens (including rifapentine and isoniazid) are similarly effective in preventing tuberculosis in people with HIV infection, but the shorter rifamycin-based regimens are associated with fewer hepatotoxic effects and are more likely to be completed than the isoniazid-based regimens.