Everything to Know About TB/HIV Coinfection - Healthline

HIV can weaken your immune system, making you vulnerable to opportunistic infections. Tuberculosis (TB), a bacterial disease that affects the lungs, other organs, and spine, is one such infection.

When you have HIV, TB coinfection can be a life threatening and "AIDS-defining" condition.

It can be difficult, but not impossible, for doctors to diagnose tuberculosis when you have an HIV-positive status. Screening blood tests for TB can be falsely negative in those with untreated HIV.

In this article, we'll provide an overview of what symptoms to look out for, how diagnosis works, risk factors, and how TB and HIV are connected.

According to the World Health Organization (WHO), people living with HIV are 18 times more likely to develop active TB. An estimated 215,000 people die each year from HIV-associated TB infection.

Experiencing TB and HIV together is a medical emergency. HIV can destroy the body's immune cells, causing immune suppression. As the National Institutes of Health (NIH) explains, this means it's much harder for your system to respond to infections like TB compared with the immune system of a person without HIV.

Doctors usually divide TB infections into two categories: latent and active.

Latent TB doesn't cause symptoms, but it is present in the body. If you have a latent TB infection, it can't be passed on to other people.

Doctors usually advise treating latent TB, which is done with antibiotics. This can prevent you from having severe symptoms if your HIV should get worse. If your HIV progresses, further weakening the immune system, a latent TB infection could become active more quickly. Not all cases of latent TB turn into active TB.

Active TB causes symptoms and is contagious. If you have active TB, seek medical treatment and quarantine, as coexisting TB and HIV infections can prove deadly.

If you have been diagnosed with HIV, it's important that your doctor test you for TB even if you don't have any symptoms. A potential latent TB infection could progress quickly with a compromised immune system, and catching it early is key.

The CDC says that screening for TB involves one of two approaches:

• Skin test. A small amount of tuberculin purified protein derivative (PPD) is injected just under the skin to see if the body reacts. Typically, you'll go home and return to your doctor within 2 to 3 days to have your reaction measured. If your skin at the injection site shows a large amount of swelling or hard bump, TB infection is indicated.
• Blood test. A nurse will use a small needle to do a blood draw, usually from a vein in your arm. This test looks for a reaction to the bacteria in your immune system.

If your screening test is positive, or if there is suspicion of active tuberculosis, your doctor may also use other diagnostic tools. For example, they may collect a sputum sample (mucus) or do a chest X-ray.

A 2017 review found that a special test called a molecular diagnostic test may be more sensitive in detecting TB. However, these tests are still expensive and difficult to access for most people.

It is possible to have a negative TB test and still have TB, especially if you have HIV. This is because your immune system doesn't work the same as the immune system of someone without HIV. If your treating doctor is not aware of your HIV-positive status, you should disclose to make sure you get the right TB tests for your health.

TB is stereotypically associated with having a bloody cough. It used to be referred to as "consumption" or "consumptive disease" because of how it weakened and debilitated the ill person.

When TB attacks the lungs, it is called pulmonary tuberculosis. But while many people think TB targets the lungs only, the condition can actually affect many other body parts, including the brain, kidneys, and spine. TB outside the lungs is called extrapulmonary tuberculosis.

According to the CDC, active TB symptoms include the following:

• a cough that doesn't go away and may have blood or mucus
• fever
• night sweats
• fatigue
• unexplained weight loss
• weakness
• chest pain
• appetite loss

TB can also mimic other health conditions.

These include:

Prompt and thorough testing can rule out other concerns and allow your doctor to make an accurate diagnosis.

It's always essential to treat TB, and the stakes are higher if you also have HIV. However, it's important to know that taking meds for both HIV and TB at the same time can cause side effects. Make sure your doctor knows every medication you are on in order to limit adverse drug interactions.

Antibiotics are the gold standard treatment for TB. Depending on the severity of your case, these may be given orally or intravenously at the hospital. Usually, a course of antibiotics for TB will last at least 6 months and may include a combination of multiple drugs.

Antibiotics used to treat TB include:

• isoniazid
• rifapentine
• rifampicin
• ethambutol
• bedaquiline

These medications can cause lasting effects, including nerve damage. A doctor may recommend taking vitamin B6 (pyridoxine) to help prevent this.

If you have active TB, your doctor will usually prescribe a combination regimen. This is a mixture of medications used to treat active TB while minimizing potential side effects.

Sometimes, TB can be resistant to certain drugs used to treat it. This is called multidrug-resistant TB (MDR-TB). It may require you to take a combination of different antibiotics to cure the infection. Some of these medications, such as bedaquiline, are more expensive and only prescribed in the case of MDR-TB.

If you are diagnosed with HIV, your doctor will likely recommend TB testing. If tests indicate you don't have latent or active TB, your doctor may still recommend treatment to prevent TB if you have certain risk factors.

These include having:

• a close contact with someone with TB
• a CD4 count (a type of white blood cell important to the immune system) that is less than 200

According to a 2021 study, preventive treatment involves taking a preemptive course of antibiotic medications, such as isoniazid or rifamycin.

TB is an airborne illness. This means you can contract it from breathing in air that has TB germs present. Whenever possible, stay away from any person who has a severe respiratory infection or potential symptoms of TB. TB can be transmitted rapidly when someone with an active infection coughs, sneezes, or just talks.

While a vaccine for tuberculosis exists, doctors usually only recommend it for children who are at risk. As a result, vaccination probably won't be a part of your TB treatment regimen.

In addition to taking TB preventive measures, it's important to treat your HIV. Preventing your HIV from worsening can also help prevent TB from becoming active if you have a latent infection. And when your body has better control of the HIV viral load, it will improve immune system functionality, helping you fight off TB.

Treatment for HIV involves antiretroviral therapy (ART). This is a medication regimen that keeps the HIV virus from replicating. Different HIV regimens exist. Your doctor can recommend one for you based on your overall health.

HIV and TB are both serious health conditions, and when combined they can become life threatening. HIV lowers your immune system, making you vulnerable to opportunistic infections like TB. If you are diagnosed with HIV, your doctor will likely recommend testing for TB.

While HIV is a lifelong condition, TB can resolve with oral or intravenous antibiotic treatment. It may take weeks to months before TB is no longer contagious and you can return to daily life.

Latent TB often doesn't have symptoms and is not contagious. Active TB may include symptoms like cough, fever, and fatigue. It is highly contagious, spreading through the air. Not all cases of latent TB become active.

People living with HIV are at higher risk than the general population of contracting TB, getting sick from a case of active TB, or even dying. It's important to stay informed and in touch with your healthcare team about your HIV treatment regimen, risk factors, and any new symptoms.

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