HIV and Opportunistic Infections, Coinfections, and Conditions

Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. The TB bacterium can spread from person to person through the air.

TB usually affects the lungs, but it can affect any part of the body, including the kidneys, spine, or brain. If not treated, TB can cause death.

When a person with TB disease of the lungs coughs or speaks, droplets of TB bacteria spread through the air. People nearby who breathe in the TB bacteria can get TB.

Once in the body, TB can be inactive or active. When the TB bacterium is inactive, this is called latent TB infection. When the TB bacterium is active, this is called TB disease. The image below shows the difference between latent TB infection and TB disease.

TB is an opportunistic infection (OI). OIs are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. HIV weakens the immune system, increasing the risk of TB in people with HIV.

Infection with both HIV and TB is called HIV/TB coinfection. Untreated latent TB infection is more likely to advance to TB disease in people with HIV than in people without HIV. In people with HIV, TB disease is considered an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV.

Treatment with HIV medicines is called antiretroviral therapy (ART). HIV medicines protect the immune system and prevent HIV from advancing to acquired immunodeficiency syndrome (AIDS). In people with HIV and latent TB infection, treatment with HIV and TB medicines reduces the chances that latent TB infection will advance to TB disease.

Worldwide, TB disease is one of the leading causes of death among people with HIV. In the United States, where HIV medicines are widely used, fewer people with HIV have TB disease than in the past. But TB disease still affects many people with HIV in the United States, especially those born outside the United States.

Yes, all people with HIV should get tested for TB infection. If test results show that a person has latent TB infection, additional testing is needed. More testing will determine whether the person has TB disease.

People with latent TB infection have no symptoms. But people with TB disease that affects the lungs may have the following symptoms:

• A persistent cough that may bring up blood or sputum
• Chest pain
• Weakness or fatigue
• Loss of appetite
• Weight loss
• Chills
• Fever
• Night sweats

When TB disease affects other parts of the body, a person may have other symptoms.

TB medicines are used to prevent latent TB infection from advancing to TB disease and to treat TB disease. The choice of TB medicines and the length of treatment depend on whether a person has latent TB infection or TB disease.

People with HIV/TB coinfection should be treated for both HIV and TB; however, when to start treatment and what medicines to take depends on a person’s individual circumstances. Taking certain HIV and TB medicines at the same time can increase the risk of drug-drug interactions and side effects. People being treated for HIV/TB coinfection are carefully monitored by their health care providers.

If you have HIV/TB coinfection, talk to your health care provider about a treatment plan that works for you.

From the Centers for Disease Control and Prevention (CDC):

• Basic TB Facts
• Tuberculosis Facts: TB and HIV/AIDS
• TB and HIV Coinfection

From the Department of Health and Human Services:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV:
• Mycobacterium Tuberculosis Infection and Disease
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
• Tuberculosis/HIV Coinfection

Also see the HIV Source collection of HIV links and resources.