Tuberculosis in HIV-infected patients: a comprehensive review

• Published in: Clinical microbiology and infection Vol. 10; no. 5; pp. 388 - 398
• Main Authors: Aaron, L., Saadoun, D., Calatroni, I., Launay, O., Mémain, N., Vincent, V., Marchal, G., Dupont, B., Bouchaud, O., Valeyre, D., Lortholary, O.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01-05-2004; Blackwell Science Ltd; Blackwell
• Subjects: AIDS; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - prevention & control; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active - adverse effects; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Drug Therapy, Combination; Fundamental and applied biological sciences. Psychology; HAART; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human bacterial diseases; Human immunodeficiency virus; Humans; Infectious diseases; Medical sciences; Microbiology; Mycobacterium tuberculosis; tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - complications; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - epidemiology; AIDS; HIV; Mycobacterium tuberculosis; tuberculosis; HAART; Immunopathology; Microbiology; Mycobacterial infection; Immune deficiency; Infection; Tuberculosis; Viral disease; Bacteriosis; Bibliographic review
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2004.00758.x

The incidence of tuberculosis (TB) is currently increasing in HIV-infected patients living in Africa and Asia, where TB endemicity is high, reflecting the susceptibility of this group of patients to mycobacteria belonging to the TB group. In this population, extension of multiple resistance to anti-tuberculous drugs is also a matter of anxiety. HIV-induced immunosuppression modifies the clinical presentation of TB, resulting in atypical signs and symptoms, and more frequent extrapulmonary dissemination. The treatment of TB is also more difficult to manage in HIV-infected patients, particularly with regard to pharmacological interactions secondary to inhibition or induction of cytochrome P450 enzymes by protease inhibitors with rifampicin or rifabutin, respectively. Finally, immune restoration induced by highly active anti-retroviral therapy (HAART) in developed countries may be responsible for a paradoxical worsening of TB manifestations.