HIV-Associated Tuberculosis in Adults: Diagnosis and Clinical Management

Human immunodeficiency virus (HIV)-associated tuberculosis (TB) is a leading cause of morbidity and mortality, and HIV fuels the TB epidemic in many countries. While there is overlap, there are also critical differences in the diagnosis and management of HIV-associated TB, compared to TB in HIV-uninfected patients. To prevent deaths, the diagnosis and treatment of TB in people with HIV (PWH) needs to occur without delay. Non-sputum-based samples are important to fill the diagnostic yield gap created by challenges obtaining sputum, and reduced sensitivity of sputum diagnostics in PWH. Management of rifampicin-susceptible HIV-associated TB remains a 6month regimen initially with four drugs; an alternative 4month rifapentine and moxifloxacin containing regimen cannot be used in certain PWH (those with CD4 count <100 cells/mm³) and is currently not widely available. Management of rifampicin-resistant TB now involves a 6month all-oral regimen for most patients, including PWH. While significant gains have recently been made toward decreasing mortality from HIV-associated TB, there are many ongoing challenges, some of which are being addressed in active clinical trials.