What is the relationship between TB and HIV infection?

Updated: Jul 27, 2020
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

With specific regard to TB, the relationship with antiretroviral therapy is complex. A large multi-national study found that the relative risk of acquiring TB after starting HAART was approximately half that of those in whom HAART was not started. However, there was evidence for immune reconstitution inflammatory syndrome (IRIS) in some patients co-infected with HIV and TB in the first few months of therapy. In addition, those older than 50, or with pretreatment CD4 T-cell counts less than 50/µL, were less likely to see the same reduction in TB incidence. [133]

Recent data support the recommendation to start ART within the first 2 weeks of initiating treatment for tuberculosis in patients with CD4 cell counts below 50/uL and within the first 2-8 weeks in those with CD4 cell counts of 50/uL or more. In patients with cryptococcal meningitis in high-resource settings with access to optimal antifungal therapy, frequent monitoring, and aggressive management of intracranial pressures, ART should begin within 2 weeks of diagnosis. Careful monitoring for immune reconstitution inflammatory syndrome is essential. In individuals diagnosed with HIV infection and malignancy concurrently, ART should be initiated immediately. Early adverse effects of ART can be monitored and managed while cancer staging and molecular testing are performed. [120]


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