HIV coinfection with tuberculosis (patient information)
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HIV coinfection with tuberculosis |
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Where to find medical care for HIV coinfection with tuberculosis? |
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HIV coinfection with tuberculosis On the Web |
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Directions to Hospitals Treating HIV coinfection with tuberculosis |
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Risk calculators and risk factors for HIV coinfection with tuberculosis |
Overview
What are the symptoms of HIV coinfection with tuberculosis?
In people with early or mild HIV infection, TB often presents with typical pulmonary symptoms such as:
- Persistent cough
- Fever and night sweats
- Weight loss and fatigue
- Chest pain or shortness of breath
In advanced HIV disease (CD4 count <200 cells/µL), TB often becomes extrapulmonary or disseminated because of severe immune suppression. Symptoms may include:
- Generalized weakness and fever
- Lymph node enlargement
- Abdominal pain or hepatosplenomegaly
- Neurologic symptoms from TB meningitis (e.g., headache, confusion)
- Pleural effusion or other serosal involvement
Many patients with advanced HIV present with nonspecific or sepsis-like illness, and almost half have mycobacteremia. These patients may show hypotension, tachypnea, or altered sensorium.[1]
What causes HIV coinfection with tuberculosis?
- Primarily; HIV damages immune defense, mainly by depleting CD4+ T-lymphocytes, which are essential for containing Mycobacterium tuberculosis. Loss of CD4+ cells leads to poor granuloma formation and reduced macrophage activation, allowing TB bacteria to spread.
- Beyond Lymphopenia (low CD4+ count), HIV also causes dysfuction of other aspects of Innate and adaptive immune system that increases the susceptibility of HIV patients to TB, even before CD4+ T-lymphocyte counts fall significantly.[1]
Who is at highest risk?
People with advanced HIV infection are at the highest risk of developing tuberculosis.
The risk of TB increases sharply as the CD4+ T-lymphocyte count drops, especially when it falls below 200 cells per microliter. Those with very low CD4 counts (<50 cells/µL) are most likely to have disseminated or severe forms of TB.
Other factors that increases risk of TB in HIV are:
- Those patients who are not on antiretroviral therapy (ART).
- Those who start ART late or have poor adherence.
- Individuals living in countries with high HIV and TB prevalence, such as parts of sub-Saharan Africa.
Therefore, Early HIV diagnosis and prompt ART can greatly reduce this risk.[1]
Diagnosis
In people with HIV, diagnosing tuberculosis (TB) can be difficult because their immune system is weak (which may mask the response to which those tests are based on; such as Mantoux test) and symptoms are often unclear.
Doctors may use several tests to find TB:
- Molecular tests such as Xpert MTB/RIF or Xpert Ultra can quickly detect TB bacteria and check for drug resistance using sputum (phlegm) or other body fluids.
- Urine tests like the LAM (lipoarabinomannan) test help find TB in very sick patients or those with low CD4 counts.
- If sputum can’t be produced, chest X-rays or ultrasound may help show signs of TB.
- Sometimes, doctors need to test blood or tissue samples (like a lymph node or pleural biopsy) to confirm the diagnosis.
These tests help detect TB early and start treatment quickly, which is especially important for people living with HIV.[1]
When to seek urgent medical care?
People living with HIV should seek urgent medical care if they develop symptoms that could mean serious or advanced tuberculosis (TB).
Warning signs (red flags) include:
- High fever, night sweats, or sudden worsening weakness
- Shortness of breath or chest pain
- Severe headache, confusion, or neck stiffness (possible TB meningitis)
- Abdominal pain or swelling
- Extreme fatigue, weight loss, or dizziness
- Any signs of sepsis such as fast heartbeat, rapid breathing, or low blood pressure
These can be signs of disseminated or severe TB, which is common in people with advanced HIV and can be life-threatening if not treated quickly.
Treatment options
People with both HIV and TB can be treated for both infections at the same time. Treatment needs to be closely managed by a doctor because the medicines can interact.
- TB treatment: Most people take a 6-month course of antibiotics that includes drugs such as rifampin, isoniazid, pyrazinamide, and ethambutol. These medicines kill the TB bacteria and help prevent relapse.
- In some cases, doctors may use a shorter 4-month regimen that includes rifapentine and moxifloxacin.
- If the TB bacteria are resistant to common drugs, newer medicines such as bedaquiline, pretomanid, linezolid, and moxifloxacin may be used for about 6 months.
- HIV treatment: Antiretroviral therapy (ART) should usually begin within 2 weeks after starting TB treatment, except for TB meningitis, where doctors may delay ART for 4–8 weeks to avoid complications.
With proper treatment and follow-up, most people recover well from TB, and treating HIV at the same time helps prevent TB from coming back.
Where to find medical care for HIV coinfection with tuberculosis?
HIV Clinics and Ryan White HIV/AIDS Program:
The Ryan White HIV/AIDS Program (funded by the U.S. Department of Health and Human Services) provides comprehensive care for people living with HIV, including those who also have TB.
- Most Ryan White–funded clinics offer integrated or coordinated care for HIV and TB.
- You can find a local provider through the HIV.gov service locator: hiv.gov/locator
World Health Organization (WHO)–Supported Clinics:
The WHO and its partners support TB/HIV collaborative programs in most countries with high burdens of both diseases.
- These are usually located within public hospitals or national TB/HIV centers.
- You can find details through the WHO’s regional offices or local ministries of health. https://www.who.int/about/who-we-are/regional-offices
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
Sources
Other sources/websites for patient information:
- https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-tuberculosis-tb
- https://aidsinfo.unaids.org/
- https://www.state.gov/pepfar/
- https://www.theglobalfund.org/en/
- https://www.who.int/health-topics/hiv-aids#tab=tab_1
- https://aidsvu.org/services/#/testing
- https://www.emro.who.int/entity/aids-and-sexually-transmitted-diseases/