Tuberculosis Associated with HIV Infection

Midori Kato-Maeda; Annie Luetkemeyer; Peter M. Small

doi:10.1128/9781555817138.ch32

Chapter 32 : Tuberculosis Associated with HIV Infection

Authors: Midori Kato-Maeda¹, Annie Luetkemeyer², Peter M. Small³

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Affiliations: 1: San Francisco General Hospital, University of California San Francisco, Francis J. Curry National Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, 1001 Potrero Ave., Building 100, Room 109, Mailbox 0841, San Francisco, CA 94110; 2: San Francisco General Hospital, University of California San Francisco, HIV/AIDS Division, 995 Potrero Ave., Box 0874, San Francisco, CA 94110; 3: Institute for Systems Biology, 1441 N. 34th St., Seattle, WA 98103-8904

Content Type: Monograph

Publication Year: 2011

Category: Clinical Microbiology; Bacterial Pathogenesis

Book DOI: 10.1128/9781555817138

Chapter DOI: 10.1128/9781555817138.ch32

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Abstract:

Tuberculosis and human immunodeficiency virus (HIV) infection are two major global public health threats that undermine the development of societies because of their high morbidity and mortality. This chapter reviews the pathogenesis of the coinfection of HIV and Mycobacterium tuberculosis (MTB), the epidemiology, and the clinical aspects of tuberculosis associated with HIV infection. Antiretroviral therapy (ART) greatly reduces the risk of tuberculosis in HIV infection, but it appears that in most populations, even after effective treatment with ART, the risk of tuberculosis is still on average 5- to 10- fold higher than in the HIV- uninfected population. Due to the high frequency of coinfection of MTB and HIV, all patients infected with HIV should be screened for latent tuberculosis infection (LTBI) and tuberculosis. Also, all patients with tuberculosis should be advised to undergo voluntary counseling and testing for HIV infection. Rifabutin is the least powerful inducer and recommended for the treatment of tuberculosis in patients with HIV infection, especially if protease inhibitors are required to treat HIV. The interaction of rifampin and rifabutin with approved antiretroviral drugs is summarized in the chapter. It is remarkable how difficult it has been to control the epidemic of tuberculosis, a curable disease. HIV is the most important factor contributing to the increase of cases of tuberculosis, but tuberculosis is both preventable and treatable even in persons with HIV infection. We need to accelerate the development of new diagnostic tools, new antituberculosis drugs, and a new effective vaccine.

Citation: Kato-Maeda M, Luetkemeyer A, Small P. 2011. Tuberculosis Associated with HIV Infection, p 481-497. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch32

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Tuberculosis Associated with HIV Infection

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/content/10.1128/9781555817138.ch32.ch32fig01

Figure 1.

Lateral chest radiograph showing extensive mid- and lower-lung field involvement and associated lymphadenopathy in a man with AIDS.

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10.1128/9781555817138/f0486-01.gif

Figure 1.

Lateral chest radiograph showing extensive mid- and lower-lung field involvement and associated lymphadenopathy in a man with AIDS.

/content/10.1128/9781555817138.ch32.ch32fig02

Figure 2.

Posteroanterior chest radiograph demonstrating extensive right lower infiltrate associated with pleural effusion.

10.1128/9781555817138/f0486-02_thmb.gif

10.1128/9781555817138/f0486-02.gif

Figure 2.

Posteroanterior chest radiograph demonstrating extensive right lower infiltrate associated with pleural effusion.

/content/10.1128/9781555817138.ch32.ch32fig03

Figure 3.

Posteroanterior chest radiograph showing extensive bilateral diffuse infiltrate in a young woman with advanced HIV infection.

10.1128/9781555817138/f0486-03_thmb.gif

10.1128/9781555817138/f0486-03.gif

Figure 3.

Posteroanterior chest radiograph showing extensive bilateral diffuse infiltrate in a young woman with advanced HIV infection.

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Tables

Tuberculosis Associated with HIV Infection

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Table 1.

Clinical characteristics of tuberculosis in patients coinfected with HIV

Table 1.

Clinical characteristics of tuberculosis in patients coinfected with HIV

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Table 2.

Recommended regimen for tuberculosis treatment

Table 2.

Recommended regimen for tuberculosis treatment

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Table 3.

Dose adjustment required when coadministering rifamycin (rifampin or rifabutin) and antiretroviral drugs ( 33 )

Table 3.

Dose adjustment required when coadministering rifamycin (rifampin or rifabutin) and antiretroviral drugs ( 33 )