Human immunodeficiency virus infection and tuberculosis: an analysis and a course of action

Tuberculosis, once on the steady decline in the western world, has resurfaced with renewed vigor in the wake of the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic. People with HIV infection are both more likely to contract primary tuberculosis and at greater risk for reactivation of latent tuberculosis. Tuberculous disease may present with atypical signs and symptoms in HIV-infected hosts because of alterations in the immune system. Superimposed on the virulent interaction of HIV and tuberculosis is the emerging problem of multidrug resistant strains that often resist currently available therapies. HIV-positive health professionals working in high-risk environments pose a special problem, while populations unable to comply with currently available pharmacological therapies pose another. We have many tools available to combat the resurgence of tuberculosis, but new methods of diagnosis and new approaches to treatment are sorely needed.