Tuberculosis in Persons with Human Immunodeficiency Virus Infection: Clinical and Public Health Aspects

Abstract

It is widely recognized that infection with the human immunodeficiency virus (HIV) imposes a high risk for developing tuberculosis, although the magnitude of the risk varies widely depending upon a number of factors. Infection with HIV causes a progressive loss of cell-mediated immunity, thereby predisposing to rapid progression after acquiring infection with M. tuberculosis and to reactivation of latent infection. Reinfection with a different strain of M. tuberculosis has also been documented. Although early in the course of HIV infection the clinical manifestations of tuberculosis are typical of the disease, as immune compromise becomes more severe the features become less typical. There is a greater frequency of extra-pulmonary involvement, cavitation is unusual and tuberculin skin tests are often negative. Generally, patients respond well to standard antituberculosis treatment although there is probably less of a margin of safety. There are, however, several specific concerns related to therapy: There are important interactions between the protease inhibitor class of antiretroviral drugs and the rifamycins and also between the azole class of antifungal agents and the rifamycins. There is also the potential for malabsorption of antituberculosis drugs. Isoniazid preventive therapy is effective in decreasing the incidence of tuberculosis among HIV-infected persons with positive tuberculin skin tests but not among those who are anergic. Data from several sources show that tuberculosis accelerates the course of HIV infection, thereby, making prevention of tuberculosis an even higher priority undertaking.

Key Words:

Human immunodeficiency virus - tuberculosis