title: Understanding and intervening in HIV-associated tuberculosis.
abstract: HIV-associated tuberculosis can present as extremes, ranging from acute life-threatening disseminated disease to occult asymptomatic infection. Both ends of this spectrum have distinct pathological correlates and require specific diagnostic and treatment approaches. Novel therapeutics, targeting both pathogen and host, are needed to augment pathogen clearance. In latent tuberculosis infection, enhancement of immune activation could be desirable. Antiretroviral therapy augments the beneficial effects of antitubercular therapy. However, in the context of high bacillary burden, antiretroviral therapy can also result in pathology (tuberculosis immune reconstitution inflammatory syndrome). In the immune reconstituting patient, modulation of immune activation controls tissue destruction. Interventions should also be appropriate and sustainable within the programmatic setting.
authors.affiliation: Department of Medicine, Imperial College London, London, UK, and Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Neesha
authors.initials: N
authors.lastname: Rockwood
authors.affiliation: Department of Medicine, Imperial College London, London, UK, and Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa, and Francis Crick Institute Mill Hill Laboratory, London, UK r.j.wilkinson@imperial.ac.uk.
authors.forename: Robert John
authors.initials: RJ
authors.lastname: Wilkinson
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D058491:Bacterial Load; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents
keywords: HIV; diagnostics; host-directed therapies; immune modulation; immune reconstitution inflammatory syndrome; latent tuberculosis infection; multibacillary; paucibacillary; tuberculosis