[HIV-tuberculosis coinfection]

Coinfection with the human immunodeficiency virus (HIV) and tuberculosis is a major public health problem throughout the world. In subsaharan Africa and Southeast Asia, as many as one third of all patients with tuberculosis also have HIV infection. These two infection interact on each other, worsening the prognosis and increasing mortality. The diagnosis of tuberculosis is sometimes difficult to establish since the clinical presentation may be incomplete, but must always be evoked and sought whenever there is the slightest doubt. These patients should be given conventional anti-tuberculosis treatment using three or four anti-tuberculosis drugs for a duration of 9 months. Overall outcome is favorable. Drug interactions between antiretroviral drugs and anti-tuberculosis drugs is a real problem, limiting the use of certain agents. The restored immunization achieved with HAART protocols involve "paradoxical" reactions which complicate patient adherence to therapy. It would be reasonable to treat tuberculosis first, then, in 6 weeks, introduce an adapted antiretroviral regimen. Prevention of tuberculosis for patients at risk should be based on rifampicin and pyrazinamid for 2 months.