Tuberculosis and HIV in the Caribbean: approaches to diagnosis, treatment, and prophylaxis

In the Caribbean region, the lifetime risk of active tuberculosis (TB) in purified protein derivative (PPD)-positive HIV-infected patients is 50%. Screening of individuals with cough who came to an HIV voluntary counseling and testing center in Haiti revealed active TB in 33% of patients. TB prophylaxis is effective in preventing active disease in HIV-infected individuals, and secondary prophylaxis has been shown to reduce recurrence in patients diagnosed with TB at more advanced stages of immunosuppression. Recommendations for anti-TB therapy differ according to whether antiretroviral therapy is available or not and according to whether the TB diagnosis is made while the patient is receiving antiretroviral therapy or not. This article summarizes a presentation by Jean William Pape, MD, at the first CHART Caribbean Conference on the Clinical Management of HIV/AIDS in Montego Bay, Jamaica in June 2004.