HIV-TB co-infection: epidemiology, diagnosis & management

HIV/AIDS pandemic has caused a resurgence of TB, resulting in increased morbidity and mortality worldwide. HIV and Mycobacterium tuberculosis have a synergistic interaction; each accentuates progression of the other. Clinical presentation of TB in early HIV infection resembles that observed in immunocompetent persons. In late HIV infection, however, TB is often atypical in presentation, frequently causing extrapulmonary disease. These factors coupled with low sputum smear-positivity, often result in a delayed diagnosis. HIV-infected patients respond well to the standard 6-month antituberculosis treatment regimens, although mortality is high. Antituberculosis treatment is complicated by frequent drug-interactions with highly active antiretroviral therapy (HAART) and adverse drug reactions are more common among HIV-infected patients. Guidelines for the management of patients co-infected with HIV and TB are still evolving. Timely institution of antituberculosis treatment using the directly observed treatment, short-course (DOTS) strategy and HAART markedly improves the outcome of HIV-infected patients with TB.