[Tuberculosis associated with the human immunodeficiency virus]

The HIV pandemic is one of the factors that have contributed to the the worldwide increase in tuberculosis cases especially in subsaharian Africa. The copathogenicity between M. tuberculosis and HIV is best illustrated by the high susceptibility of the HIV-infected persons for reactivation of a remote tuberculous infection or early progression of a newly acquired disease and by the negative impact of tuberculosis on natural history of HIV characterised by increased incidence of clinical progression and increased mortality rates. Clinical presentation is rather atypical and severe when immune suppression is advanced: no cavitation on the chest X-rays, visceral ganglionnar involvement with frequent fistulization, positive blood cultures. A standard 6 months antituberculous therapy has the same efficacy as in HIV uninfected patients excepted in severe cases especially if immunosuppression is advanced when 9 months treatment are recommended. Higher frequency of side effects to the antituberculous drugs and drug interactions between the rifamycin and several antiretrovirals due to the induction or inhibition of the CYP3A could interfere with the treatment of the tuberculosis. Paradoxical reaction to the antituberculous therapy after immuno-restoration is induced by the combined antiviral therapy has also been reported. Isoniazid prophylaxis is recommended in patients with a induration of more than 5 mm on PPD skin test and is associated with a 60% reduction of risk of development of tuberculosis.