Tuberculosis and HIV Coinfection

Abstract

The human immunodeficiency virus (HIV) pandemic has amplified the global burden of tuberculosis (TB), particularly in sub-Saharan Africa, where 82% of the world's TB/HIV coinfection exists. HIV infection significantly increases the risk of developing and dying from TB and was associated with 350,000 TB deaths in 2010. The diagnosis of HIV-associated TB is often challenging due to atypical clinical and radiographic manifestations, more frequent extrapulmonary disease, and higher rates of smear-negative pulmonary TB. Nucleic acid amplification tests, including the Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), improve our ability to rapidly diagnose both smear-negative and extrapulmonary TB. The standard 6-month anti-TB regimen is usually adequate for HIV coinfected persons, but intermittent dosing in the intensive phase should be avoided because of an increased risk of relapse with acquired rifamycin resistance. The comanagement of HIV and TB is challenging due to drug-drug interactions, overlapping drug toxicities, concerns about adherence, and the immune reconstitution inflammatory syndrome. However, the initiation of antiretroviral therapy (ART) during the course of TB treatment is necessary to improve survival, and the appropriate timing of ART is dependent on the level of immune suppression. Therefore, the management of TB must be well coordinated with HIV resources, prepared to rapidly diagnose HIV, assess immune status, and correctly treat both infections.

Tuberculosis treatment outcomes among disadvantaged patients in India

“…This has been suggested to be related to HIV prevalence, especially advanced HIV disease, which is associated with low bacillary burden in the sputum 34. While extra-pulmonary TB has been associated with longer treatment delays,35 HIV infection36 and worse outcomes than pulmonary TB,26 higher treatment success among extra-pulmonary patients has also been reported 37. This depends partly on the site of extra-pulmonary disease; for example, meningeal and disseminated TB have higher mortality rates than lymphatic TB 38.…”

Pathogenic mycobacteria achieve cellular persistence by inhibiting the Niemann-Pick Type C disease cellular pathway

“…TB causes around 1.5 million deaths per year 1 , a significant number of which are in immune-compromised individuals 2 . The only approved vaccine, Bacillus Calmette-Guerin (BCG) has limited efficacy 3 and the emergence of antibiotic-resistant TB strains has led to a reduction in available therapeutic options.…”

Prevalence of national treatment algorithm defined smear positive pulmonary tuberculosis in HIV positive patients in Brazzaville, Republic of Congo

“…The diagnosis of HIV-associated TB is often challenging and nucleic acid amplification tests, including the GeneXpert MTB/RIF assay and urinary LAM assays are known to improve the diagnosis of both smear-negative and extrapulmonary TB in HIV positive individuals [12]. …”