Tuberculosis in HIV-infected patients: a comprehensive review

Abstract

The incidence of tuberculosis (TB) is currently increasing in HIV-infected patients living in Africa and Asia, where TB endemicity is high, reflecting the susceptibility of this group of patients to mycobacteria belonging to the TB group. In this population, extension of multiple resistance to anti-tuberculous drugs is also a matter of anxiety. HIV-induced immunosuppression modifies the clinical presentation of TB, resulting in atypical signs and symptoms, and more frequent extrapulmonary dissemination. The treatment of TB is also more difficult to manage in HIV-infected patients, particularly with regard to pharmacological interactions secondary to inhibition or induction of cytochrome P450 enzymes by protease inhibitors with rifampicin or rifabutin, respectively. Finally, immune restoration induced by highly active anti-retroviral therapy (HAART) in developed countries may be responsible for a paradoxical worsening of TB manifestations.

CD4 + T-cell–independent mechanisms suppress reactivation of latent tuberculosis in a macaque model of HIV coinfection

“…In general, reactivators not only harbored greater bacterial burden in their spleen, liver, and kidney relative to LTB and nonreactivators but also relative to animals with ATB. These microbiological results display similar qualities to human TB/HIV coinfection, where high bacterial burden and increased dissemination have been well documented (27,28).…”

Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

“…This could indicate possible late health care seeking with advanced TB-HIV disease, associated with atypical clinical presentations such as EPTB. 22 This was observed in at least one in four patients presenting with EPTB among the adolescent and older age groups. Given the high HIV testing rates observed in this cohort, Age-stratified TB treatment outcome 216 Public Health Action the higher rate of unfavourable outcomes observed among the few TB patients with unknown HIV status may reflect a subpopulation that declined HIV testing and that was likely to be HIV-positive.…”

IFN-Stimulated Gene LY6E in Monocytes Regulates the CD14/TLR4 Pathway but Inadequately Restrains the Hyperactivation of Monocytes during Chronic HIV-1 Infection

“…For instance, HIV-infected individuals are vulnerable to Mycobacterium tuberculosis infection, and reactivation of latent M. tuberculosis occurs more often in HIV-infected individuals than in those who are not infected with HIV (49,50). Coinfection with HIV and M. tuberculosis is likely to result in dissemination of M. tuberculosis (51). Lung granulomas from M. tuberculosis/ HIV-1-coinfected patients display decreased in situ TNF production (52) Our data revealed that LY6E exerts its role through downregulating CD14 expression at the transcriptional step but not the stage of protein stability or degradation.…”