Tuberculosis in patients with HIV infection

The close connection between tuberculosis and HIV infection was evident since the onset of the epidemic. The spread of HIV has contributed to the increased incidence of tuberculosis world-wide. With the progressively impaired cell-mediated immunity, HIV alters the pathogenesis of tuberculosis and markedly increases the risk of tuberculosis in simultaneously infected subjects. An altered pathogenesis of tuberculosis leads to a more frequent extrapulmonary involvement and atypical radiologic findings. Furthermore, HIV infection is one of the major factors of increased risk of M. tuberculosis multidrug resistance. Even if tuberculosis in HIV-positive patients to some extent can be treated and prevented, it spread in this population is increasing and at present tuberculosis represents the most common opportunistic HIV-related infection several areas world-wide and globally, the first cause of death of HIV-infected patients.