A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults

ABSTRACT

Background: Tuberculosis (TB) is an important cause of mortality and morbidity in human immunodeficiency virus (HIV) infection in Africa. The interaction between TB and HIV infections is reviewed. Methods: Literature on TB; HIV and their co-infection; especially in sub-Saharan Africa; including Nigeria; is reviewed. Results: Burden of TB is fueled by the HIV epidemic; and clinical presentation of TB may be atypical with co-infection. Recommendations on drugs and timing of antiretroviral therapy (ART) initiation are discussed. Use of cotrimoxazole prophylaxis (CPT) in co-infected patients reduces morbidity and mortality; while the principles of TB prevention in HIV infection can be summarized with the three I's intensive TB case finding and surveillance; isoniazid preventive therapy (IPT) and infection-control measures; to these can be added a fourth 'I;' viz.; instituting ART. Clinical complications like drug resistance; toxicity and drug interactions; and immune reconstitution inflammatory syndrome (IRIS) with CPT; IPT and ART are highlighted. Emergence of drug-resistant- and nosocomial- TB in HIV infection poses serious challenges and potential consequences in Africa; and appropriate measures are recommended. Conclusions: Many barriers exist for optimizing the care of the two diseases; but the aim should be strengthening capacities; collaborations; linkages and eventually integrating the services. Interventions for TB prevention in HIV infection should be widely implemented