Review article

Tuberculosis in HIV-infected patients

Marta Perović Mihanović ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Croatia
Josip Begovac ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Croatia
Klaudija Višković ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Croatia
Ivan Puljiz ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Croatia

Abstract

Tuberculosis and HIV co-infection still presents a significant cause of mortality in the world, especially in Africa, although their incidence has been declining since 2005. Tuberculosis can occur at any stage of HIV-infection, and the risk of developing the disease as well as its atypical forms is higher as cell immunity is impaired. Clinical picture and radiological presentation of infection caused by Mycobacterium tuberculosis among HIV-infected persons early in the course of HIV-infection, while the immune system is still intact, is similar as in seronegative persons. With the decline in the absolute CD4+ T lymphocyte count, atypical clinical manifestations of tuberculosis appear, as well as extrapulmonary and disseminated forms of disease. For microbiological diagnostics in symptomatic patients three sputum samples for microscopic analysis and cultivation should be collected, regardless of the lung X-ray findings. In advanced HIV disease and in patients without cavitation, the sputum finding is often negative. Newer molecular nucleic acid amplification methods are used for rapid diagnostics in contrast to classical cultivation methods that are more time consuming. When there is a clinical suspicion of extrapulmonary form of disease it is necessary to take samples from other tissues as well, such as lymph nodes, pleura, pericardium, and cerebrospinal fluid. In case of positive finding of M. tuberculosis anti-TB susceptibility testing should be carried out. The treatment of tuberculosis in HV-infected persons is in principle the same as in people not infected with HIV. During simultaneous treatment of HIV-infection and tuberculosis one should take into account the interaction between individual antiretroviral and antituberculotic agents as well their possible toxicity. In persons co-infected with tuberculosis and HIV, antiretroviral therapy should begin (or be continued) during tuberculosis treatment regardless of the CD4+ T lymphocyte count. Tuberculosis-associated immune reconstitution inflammatory syndrome occurs in two forms, paradoxical and unmasking. It usually develops within the first three months from the start of antiretroviral treatment. The treatment is usually symptomatic, and in severe cases corticosteroids are used.

Keywords

HIV-infection; tuberculosis

Hrčak ID:

133426

URI

https://hrcak.srce.hr/133426

Publication date:

30.6.2013.

Article data in other languages: croatian

Visits: 2.384 *