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Tuberculosis as an opportunistic disease in persons infected with human immunodeficiency virus
1Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA.
Abstract:
Tuberculosis, a bacterial disease caused by the Mycobacterium tuberculosis complex, is becoming an increasingly common opportunistic disease in persons infected with the human immunodeficiency virus (HIV). M. tuberculosis is transmitted from person-to-person by airborne droplet nuclei. Persons who are exposed to these droplet nuclei in poorly ventilated environments are at risk of becoming infected with M. tuberculosis. HIV infection is probably the most significant risk factor associated with progression from latent M. tuberculosis infection to active disease. Thus, HIV-infected persons should avoid exposure to M. tuberculosis, they should be screened for evidence of latent infection with the tuberculin skin test, and they should be offered preventive therapy. Because many severely immunosuppressed anergic HIV-infected persons have been found to have an increased risk of developing active tuberculosis, decisions to use preventive therapy should be individualized on the basis of the local prevalence of tuberculosis and drug-resistance patterns. Persons with active tuberculosis should receive at least 6 months of treatment with recommended regimens, preferably with directly observed therapy, to ensure adequate bacteriologic response, completion of therapy, and cure. Chronic suppressive therapy after completion of therapy is currently not recommended.
Insights
Human immunodeficiency virus (HIV) increases tuberculosis risk. HIV-infected individuals need preventive therapy and screening for latent tuberculosis infection, alongside a 6-month treatment for active disease.
Area of Science:
- Infectious Diseases
- Public Health
- Immunology
Background:
- Tuberculosis (TB) is a growing opportunistic infection in individuals with human immunodeficiency virus (HIV).
- Mycobacterium tuberculosis (M. tuberculosis) spreads via airborne droplet nuclei, posing risks in poorly ventilated areas.
- HIV infection is a primary risk factor for latent TB progressing to active disease.
Purpose of the Study:
- To highlight the increased risk of TB in HIV-infected individuals.
- To outline recommendations for TB prevention and treatment in this population.
- To emphasize individualized approaches for preventive therapy decisions.
Main Methods:
- Literature review on TB and HIV co-infection.
- Analysis of risk factors for TB progression in HIV patients.
- Review of current guidelines for TB screening, preventive therapy, and treatment.
Main Results:
- HIV-infected persons are at high risk for TB and should avoid exposure.
- Screening for latent TB infection using the tuberculin skin test is recommended for HIV-infected individuals.
- Preventive therapy decisions should be individualized based on local TB prevalence and drug resistance, especially for immunosuppressed patients.
Conclusions:
- HIV-infected individuals require proactive TB management, including screening and preventive therapy.
- Active TB in HIV patients necessitates a minimum of 6 months of directly observed therapy.
- Chronic suppressive therapy post-treatment is not currently recommended.
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