Tuberculosis: A Clinical Practice Guide

Tuberculosis in Persons Living with HIV

Author(s): Rafael Laniado-Laborín

Pp: 94-105 (12)

DOI: 10.2174/9789811488511120010012

* (Excluding Mailing and Handling)

Abstract

The lifetime risk of developing active TB in subjects with latent tuberculosis infection without the human immunodeficiency infection (HIV) co-infection is 5-10%; for people living with HIV (PLWHIV), the annual risk is 3-16% per year.

The interaction of these two pathogens is complex: HIV-1 co-infection is the most significant risk factor for developing active tuberculosis, while M. tuberculosis coinfection leads to increased viral replication and disease progression.

Clinical presentation will vary depending on the degree of immunodeficiency. Patients with higher CD4 cell counts can present with the classic symptoms, while the clinical presentation of TB in patients with advanced immunodeficiency (less than 200 cells/mm3) is usually atypical. Extrapulmonary tuberculosis is more frequent among co-infected individuals regardless of the CD4 cell counts, occurring in up to 70% of patients with CD4 counts of ≤100 and about 30% of subjects with counts of >300 cells/mm3.

The diagnostic approach in subjects with TB-HIV-1 co-infection is the same as that of patients without HIV infection, with the goal being the microbiologic confirmation of the diagnosis.

Antiretroviral (ART) should be started in all TB patients living with HIV regardless of their CD4 cell count. Antituberculosis treatment should be initiated first, followed by ART as soon as possible within the first 8 weeks of treatment. Unfortunately, the restoration of the immune response sometimes has an undesirable effect known as immune reconstitution inflammatory syndrome (IRIS).


Keywords: Antiretrovirals, HIV, IGRA´S, Immunodeficiency, Tuberculosis.Antiretrovirals, HIV, IGRA´S, Immunodeficiency, Tuberculosis.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1740551972 and j.to_date >= 1740551972 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14371) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1740551972 and j.to_date >= 1740551972 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14371) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1740551972 and j.to_date >= 1740551972 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14371)
      780μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2923 and `b`.`banner_from_date` <= 1740551972 and `b`.`banner_to_date` >= 1740551972 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.23msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2923
      • 3: 1740551972
      • 4: 1740551972
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='98eb69847b9038653f0112e666ca54f2'
      480μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    9Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        jvBgxUJcYXQ2hGQYwJ9NhfDVwQqo5ajD6AyaQ7ad
        uc_cart_id
        98eb69847b9038653f0112e666ca54f2
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14371" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/14371
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6Ill3UmhySmt6dGtLWkxGYU9BQ3lnbGc9PSIsInZhbHVlIjoiaytCbHUvb21XL01uV0wzWHUwRzg2U3FwcmNKYU00N3plZnErclcwSXYrVT0iLCJtYWMiOiJjZjk1OTdkMTYzYzk0ZTczNGEyYTZjM2YwYmIzZThlMjcyMzQ4ZTA0ZWM1ODAyZWMwMWE5MWNmMzNjMjY3MTNiIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6Ill3UmhySmt6dGtLWkxGYU9BQ3lnbGc9PSIsInZhbHVlIjoiaytCbHUvb21XL01uV0wzWHUwRzg2U3FwcmNKYU00N3plZnErclcwSXYrVT0iLCJtYWMiOiJjZjk1OTdkMTYzYzk0" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Wed, 26 Feb 2025 06:39:32 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IldRRElkMi9VODJGK3RqMEF1MTE2WlE9PSIsInZhbHVlIjoicXFJVWYwUDVBNWg4VjJTUm54RHRpVERVWnNHMDNLR29wTTd1ams4Q2JHNFdMRk9mMFhHM1NyanR1T2swUTNadDBEQzBkemNqcnFvTlpQNEh1UFk4K0prNC9FWi8wM3ZURElpRXFLV0dIemEyM0VCNTVIblhjWC9jUUdPSkRFTEgiLCJtYWMiOiJmZmEzZjc1NjQ2OTkxN2FhNGFjODJhYzljZmZkOThhNzE2ZGUzYTk0MmJjNGZlNDNmYTJmZDBiNjMxZDJkZGQwIiwidGFnIjoiIn0%3D; expires=Fri, 28 Feb 2025 18:39:32 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IldRRElkMi9VODJGK3RqMEF1MTE2WlE9PSIsInZhbHVlIjoicXFJVWYwUDVBNWg4VjJTUm54RHRpVERVWnNHMDNLR29wTTd1ams4Q2JHNFdMRk9mMFhHM1NyanR1T2swUTNadDBEQzBke" 1 => "alphaeurekaselectnet_session=eyJpdiI6IlJJVkFjY29NanhRclZrVXZxVjBOcHc9PSIsInZhbHVlIjoiMlk3Mkc2WnhUSHV4YkNSU3J0M3NxMXZ5TDlxU2xHQUFFZUJwODZ4YlhiL3hnKzd3UFdjMTA3YXJOK0FRdi9ibUZuZ3poeE9OczJYYzM1ZU9iTUhGSHNxNDQzTVhzMmtPL2p1bDQ5a2FGUzZqOGRtUHRWVG1xNk5uaUNYMXpHYUQiLCJtYWMiOiI1NGE2YmFkMmQxMjZlYWY4YTY4MGZiNzg1MmFmMDg0M2Q1OTM3YTZhOGFiYTkxNGZlMjhmZGEwZDI1YTg4OGUwIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IlJJVkFjY29NanhRclZrVXZxVjBOcHc9PSIsInZhbHVlIjoiMlk3Mkc2WnhUSHV4YkNSU3J0M3NxMXZ5TDlxU2xHQUFFZUJwODZ4YlhiL3hnKzd3UFdjMTA3YXJ" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IldRRElkMi9VODJGK3RqMEF1MTE2WlE9PSIsInZhbHVlIjoicXFJVWYwUDVBNWg4VjJTUm54RHRpVERVWnNHMDNLR29wTTd1ams4Q2JHNFdMRk9mMFhHM1NyanR1T2swUTNadDBEQzBkemNqcnFvTlpQNEh1UFk4K0prNC9FWi8wM3ZURElpRXFLV0dIemEyM0VCNTVIblhjWC9jUUdPSkRFTEgiLCJtYWMiOiJmZmEzZjc1NjQ2OTkxN2FhNGFjODJhYzljZmZkOThhNzE2ZGUzYTk0MmJjNGZlNDNmYTJmZDBiNjMxZDJkZGQwIiwidGFnIjoiIn0%3D; expires=Fri, 28-Feb-2025 18:39:32 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IldRRElkMi9VODJGK3RqMEF1MTE2WlE9PSIsInZhbHVlIjoicXFJVWYwUDVBNWg4VjJTUm54RHRpVERVWnNHMDNLR29wTTd1ams4Q2JHNFdMRk9mMFhHM1NyanR1T2swUTNadDBEQzBke" 1 => "alphaeurekaselectnet_session=eyJpdiI6IlJJVkFjY29NanhRclZrVXZxVjBOcHc9PSIsInZhbHVlIjoiMlk3Mkc2WnhUSHV4YkNSU3J0M3NxMXZ5TDlxU2xHQUFFZUJwODZ4YlhiL3hnKzd3UFdjMTA3YXJOK0FRdi9ibUZuZ3poeE9OczJYYzM1ZU9iTUhGSHNxNDQzTVhzMmtPL2p1bDQ5a2FGUzZqOGRtUHRWVG1xNk5uaUNYMXpHYUQiLCJtYWMiOiI1NGE2YmFkMmQxMjZlYWY4YTY4MGZiNzg1MmFmMDg0M2Q1OTM3YTZhOGFiYTkxNGZlMjhmZGEwZDI1YTg4OGUwIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IlJJVkFjY29NanhRclZrVXZxVjBOcHc9PSIsInZhbHVlIjoiMlk3Mkc2WnhUSHV4YkNSU3J0M3NxMXZ5TDlxU2xHQUFFZUJwODZ4YlhiL3hnKzd3UFdjMTA3YXJ" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "jvBgxUJcYXQ2hGQYwJ9NhfDVwQqo5ajD6AyaQ7ad" "uc_cart_id" => "98eb69847b9038653f0112e666ca54f2" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14371" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-26 06:39:32GET/chapter/143711121911