TB-HIV

Epidemiology of TB-HIV

33.2 million infected with HIV, one-third are also

be infected with M. tb.

2008, 1.4 million new cases of TB among HIV

infection, and TB 26% of AIDS-related deaths.

The relative risk of TB among HIV, 20 and 37

fold

In 2008, 1.4 million patients with TB more than

half for HIV.

Only 4% with HIV were screened for TB in the

same year.

Epidemiology of HIV
infection

2008, 33.2 million infected with HIV, 2.1

million were children.

2.7 million persons with HIV in 2007, and 2.1

million died of AIDS.

two-thirds of all persons infected with HIV

live in sub-Saharan Africa

The majority of HIV-infected persons do not

know their HIV status

several studies showed that only 1 of 5

persons knows his or her HIV status

80% of all HIV infections are sexually

transmitted, and 10% are in injection drug
users

2008, 14 million receiving antiretroviral

therapy (ART)

the symptoms,clinical feature of

TB-HIV
HIV positive people with pulmonary TB may
have
the classic symptoms of TB,
few symptoms of TB or even less specific

ones.

up to a fifth of people have normal chest X-rays

have so called "sub clinical" TB, are delays in

both TB diagnosis and TB treatment.

have extra pulmonary TB (48 %)

Diagnosis of active TB disease in HIV-infected

persons is difficult fewer bacilli in their
sputum

Atypical Presentation and

Extrapulmonary TB

Subacute systemic and respiratory symptoms,

fever (88%), weight loss (79%), cough (79%),
and diarrhea, which last 6 weeks on average

Lower CD4 counts are associated with more

severe systemic symptoms

Chest X-ray are typically upper lobe inltrates,

cavitations and/or pleural disease

after the initiation of antiretroviral therapy

(ART), patients can also present with TBassociated immune reconstitution inammatory
syndrome

CD4 < 200 cells have atypical CXR ndings,

including pleural effusion, lower or middle
lobe inltrates,mediastinal adenopathy,
interstitial nodules, or a normal CXR.

As the CD4 cell count declines, the

frequency of cavitation in pulmonary TB
decreases.

Ziehl-Neelsenstained sputum smears,

low sensitivity, Mycobacterial culture is the
gold standard

Symptoms of extrapulmonary TB included

fever (95%), respiratory symptoms (66%),

lymphadenopathy (62%), gastrointestinal

symptoms (37%) with diarrhea and abdominal
pain, and neurological symptoms (29%), including
confusion and headache

extrapulmonary TB involving
bone marrow, blood, or liver; genitourinary TB;

peripheral lymphadenitis; pleural TB; mediastinal

TB; central nervous system (CNS) TB with
meningitis, intra-abdominal lymphadenitis or
peritonitis; musculoskeletal abscesses or
osteomyelitis; adrenal glands and the
gastrointestinal tract

the supportive examination of TBHIV

Many people with HIV will have a

false negative result from a TB
sputum smear test.

large number of cases of active

TB disease going undiagnosed.

The Stop TB Partnership's Global

Plan to Stop TB, now has as a
target, that by 2015, all patients
with TB should be tested for HIV.

Screening and Diagnosis with

either a tuberculin skin test
(TST) or gamma interferon

who test positive, a CXR

should be obtained.

three sputum samples for AFB

smear and culture in the
morning on different days

Although culture is the gold

standard for the diagnosis of
active TB, culture results take 2
to 6 weeks, and culture is not
currently an available
diagnostic option

Centarl bronchiectasis and LULobe cavity

conventional light microscopy examination of

Ziehl-Neelsen-stained direct smears

Microscopic observation drug susceptibility

(MODS) assays have been developed for the
diagnosis of TB and the detection of drugresistant TB results in 14 days for most
samples.

The Xpert MTB/RIF assay is a newly

developed automated real-time PCR assay
for TB and resistance to rifampin (RIF)

For extrapulmonary TB guidelines AFB

smear and culture of tissue or uid aspiration
or biopsy specimens and mycobacterial
blood cultures

For smear-negative pulmonary TB, two

sputum specimens, HIV testing, CXR, and
sputum culture if possible

the management of TB-HIV

isoniazid in preventing tuberculosis among

persons with HIV infection 300 mg/day for 9
months is currently recommended

Treatment for TB should be initiated promptly

whenever a positive AFB smear is found in a
patient with proven or suspected HIV infection.

Recommended treatment for TB in HIV-infected

patients is now essentially the same as that for
non-HIV infected patients

2 RHZE/RH 6-9

Concurrent therapy with various antiretroviral

and anti-TB medications seems to be well
tolerated

the dosage of both rifabutin and the retroviral

drugs may need to be adjusted to avoid
either sub-therapeutic or toxic levels

Although HIV-infected patients rarely die

from TB when it is treated appropriately,
subsequent death from disease caused by
nontuberculous organisms may occur within
one to two years

TB, CD4 < 50 cel/mm3, TB

extrapulmonal Treatment for TB
should be initiated, Treatment for ARV
should be initiated if tolerable

CD4 50-200 cel/mm3 Treatment for TB

should be initiated ARV after 2 month

CD4 > 200 cel/mm3 Treatment for TB

should be initiated ARV after
treatment TB finished