HIV-associated tuberculosis

Abstract

Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV. HIV-associated TB disproportionally affects African countries, particularly vulnerable groups at risk for both TB and HIV. Currently available TB diagnostics perform poorly in people living with HIV; however, new diagnostics such as Xpert Ultra and lateral flow urine lipoarabinomannan assays can greatly facilitate diagnosis of TB in people living with HIV. TB preventive treatment has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Shorter regimens using rifapentine can support increased availability and scale-up. Mortality is high in people with HIV-associated TB, and timely initiation of ART is critical. Programs should provide decentralized and integrated TB and HIV care in settings with high burden of both diseases to improve access to services that diagnose TB and HIV as early as possible. The new prevention and diagnosis tools recently recommended by WHO offer an immense opportunity to advance our fight against HIV-associated TB. They should be made widely available and scaled up rapidly supported by adequate funding with robust monitoring of the uptake to advance global TB elimination.

Diagnostic Value of Interferon-Gamma Release Assays for Tuberculosis in the Immunocompromised Population

“…HIV increases the risk of tuberculosis disease progression, while M. tuberculosis reduces CD4 + T-cells recovery and increases acquired immune deficiency syndrome progression. Globally, tuberculosis is the leading cause of death for persons living with HIV, accounting for a third (208,000) of the estimated 690,000 HIV-related deaths in 2019 [ 50 ]. For the people co-infected with M. tuberculosis and HIV, the risk of progression to ATBI is 10% annually [ 51 ].…”

“…For the people co-infected with M. tuberculosis and HIV, the risk of progression to ATBI is 10% annually [ 51 ]. Data showed that HIV-infected people had up to 23 times more tuberculosis progression than non-HIV-infected ones and a higher risk of developing multidrug-resistant tuberculosis [ 52 ] and extrapulmonary and disseminated diseases [ 50 ]. Even when the level of CD4 + T-cells is high, there is still an increased risk.…”

“…Cough, fever, night sweats, and weight loss are common and nonspecific. Fewer cavities are found in pulmonary tuberculosis, while extrapulmonary tuberculosis commonly involves the pleura, lymph node, central nervous system, abdominal organs, pericardium, and bone [ 50 ]. IGRAs have suboptimal sensitivity and specificity in the diagnosis of ATBI in HIV-infected people.…”

The Role of CD4+CD8+ T Cells in HIV Infection With Tuberculosis

“…TB group : individuals recruited from Wuhan Pulmonary Hospital with a confirmed diagnosis of TB by etiological or histopathological methods (positive smear or culture, and/or positive MTB DNA test, and/or positive Xpert MTB/RIF test, and/or histopathological evidence supporting TB) and negative HIV Abs ( 3 ). HIV group : individuals recruited with HIV infection confirmed by HIV RNA detection and HIV antibody screening, but excluding MTB infection by chest X-ray and IGRA at the AIDS Clinical Guidance and Training Center, Zhongnan Hospital of Wuhan University ( 4 ). HT group : individuals recruited with confirmed HIV and TB infection by the above diagnostic method at Zhongnan Hospital of Wuhan University.…”

“…Patients with human immunodeficiency virus (HIV) infection and TB represent a serious threat to public health worldwide ( 2 , 3 ). HIV may potentiate mycobacterial virulence factors and has a significant impact on the progression of TB ( 4 , 5 ). TB also promotes cellular susceptibility to HIV and drives HIV replication ( 5 , 6 ).…”