HIVTB

HIVTB is a term used to describe the coinfection of human immunodeficiency virus (HIV) and tuberculosis (TB), focusing on how the two infections interact and affect patient outcomes. HIV infection weakens the immune system, particularly CD4+ T cells, increasing the risk that latent TB becomes active and that disseminated TB occurs. TB, in turn, can accelerate HIV disease progression and complicate clinical management. The coinfection is a major global health concern, with the highest burden in sub-Saharan Africa and parts of Asia.

Clinical features and diagnosis commonly differ from TB in HIV-negative individuals. HIV-associated TB may present with atypical symptoms, may be smear-negative, and extrapulmonary TB is more frequent. Diagnosis relies on sputum smear microscopy, culture, and rapid molecular tests such as Xpert MTB/RIF; chest radiography supports evaluation, though findings can be nonspecific in advanced HIV. Screening for latent TB infection with TST or IGRA is recommended in people with HIV, and all should be evaluated for active TB before starting preventive therapy.

Treatment and management require coordinated care for both infections. Drug interactions between rifamycins (rifampin or rifapentine) and antiretroviral therapy necessitate regimen adjustments. In many cases, efavirenz-based ART is compatible with rifampin; alternative regimens may be needed. Initiation of ART should be timely, typically within 2 weeks for those with very low CD4 counts or disseminated TB, and within 2–8 weeks for others. The standard first-line TB regimen is 6 months (2 months of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampin); multidrug-resistant TB requires longer, specialized regimens. Prevention strategies include TB preventive therapy for people with HIV, infection control measures, and integrated HIV-TB services to improve adherence and outcomes.