HIV coinfection with tuberculosis natural history, complications and prognosis

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Natural History

Until the a couple of years ago Tuberculosis was visualised in a dichotomous state of Latent phase or Active disease.But with the recent advances in the Imaging modalities and screening tests TB is conceptualized as a continuous spectrum of disease stages from latent to subclinical to symptomatic, active disease.

• In people with HIV and Mild immuno-suppression ,it usually presents as in people without hiv i.e as pulmonary tuberculosis.
• People with HIV infection who have severe immunosuppression (CD4+ T-lymphocyte count, <200 per microliter)most commonly present to the clinic with Extra Pulmonary Tuberculosis.The most common sites being Lymph nodes,Liver,Spleen, Serosal surfaces ( resulting in Effusions) and CNS.

People with severe immunosuppreession can have accelerated progression of disease course and many a times it mimics acute bacterial infections.