HIV-associated tuberculosis: clinical update.
The human immunodeficiency virus (HIV) epidemic has led to an increase in the incidence of tuberculosis globally, particularly in sub-Saharan Africa. Coinfection with HIV leads to difficulties in both the diagnosis and treatment of tuberculosis. Because of the poor performance of sputum smear microscopy in HIV-infected patients, more sensitive tests-such as liquid culture systems, nucleic acid amplification assays, and detection of mycobacterial products in various body fluids-are being investigated. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs to be administered concomitantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution syndrome. Both multidrug-resistant and extensively drug-resistant tuberculosis can spread rapidly among an immunocompromised population, with resulting high mortality rates. Current guidelines recommend starting antiretroviral treatment within a few weeks of antituberculosis therapy for patients with CD4 cell counts <350 cells/microL; however, important questions about the drug regimens and timing of antiretroviral therapy remain. Ongoing trials may answer many of these unresolved questions.
Swaminathan
Soumya
S
Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India. doctorsoumya@yahoo.com
Padmapriyadarsini
C
C
Narendran
G
G
D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D017408:Guidelines as Topic; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
D019380:Anti-HIV Agents; D000995:Antitubercular Agents