Tuberculosis Associated with HIV Infection

Tuberculosis and human immunodeficiency virus (HIV) infection are two major global public health threats that undermine the development of societies because of their high morbidity and mortality. This chapter reviews the pathogenesis of the coinfection of HIV and Mycobacterium tuberculosis (MTB), the epidemiology, and the clinical aspects of tuberculosis associated with HIV infection. Antiretroviral therapy (ART) greatly reduces the risk of tuberculosis in HIV infection, but it appears that in most populations, even after effective treatment with ART, the risk of tuberculosis is still on average 5- to 10- fold higher than in the HIV- uninfected population. Due to the high frequency of coinfection of MTB and HIV, all patients infected with HIV should be screened for latent tuberculosis infection (LTBI) and tuberculosis. Also, all patients with tuberculosis should be advised to undergo voluntary counseling and testing for HIV infection. Rifabutin is the least powerful inducer and recommended for the treatment of tuberculosis in patients with HIV infection, especially if protease inhibitors are required to treat HIV. The interaction of rifampin and rifabutin with approved antiretroviral drugs is summarized in the chapter. It is remarkable how difficult it has been to control the epidemic of tuberculosis, a curable disease. HIV is the most important factor contributing to the increase of cases of tuberculosis, but tuberculosis is both preventable and treatable even in persons with HIV infection. We need to accelerate the development of new diagnostic tools, new antituberculosis drugs, and a new effective vaccine.