Tuberculosis and HIV Coinfection: Advances and Remaining Concerns

Tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS) are the leading causes of death from single infectious agents in low- and middle-income countries. Moreover, in the individual host, the two pathogens, Mycobacterium tuberculosis and human immunodeficiency virus (HIV), potentiate one another, accelerating the deterioration of immunological functions. In high-burden settings, HIV coinfection is the most important risk factor for TB disease, due to reactivation. Susceptibility to primary TB infection, or reinfection, is also elevated in people living with HIV (PLWH). TB disease also has a negative impact in PLWH not receiving antiretroviral therapy (ART), accelerating the progression to AIDS. The clinical management of HIV-associated TB includes the integration of effective TB treatment, use of concurrent ART, prevention of HIV-related comorbidities, management of drug cytotoxicity, and prevention/treatment of immune reconstitution inflammatory syndrome.