Tuberculosis
& HIV
Healthy Living With HIV www.patientedu.org/hiv
T Tuberculosis, or TB, is a serious infection that kills more people with HIV worldwide than any other disease. HIV and TB both make each other worse, but there are effective treatments that target these infections. Treatments should be carefully planned. Together with your healthcare provider, you can conquer this infection and continue to lead a long, healthy life with HIV.
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uberculosis (TB) is an opportunistic infection that is caused by bacteria. It usually affects the lungs, but sometimes can affect other organs. TB has become a very serious disease worldwide, with almost a third of the world’s population having the infection. Alarmingly, another third of people living with HIV are infected with TB. A healthy immune system can usually prevent active TB disease, but people with HIV have immune systems that are not as healthy as they should be. TB can be dangerous for those living with HIV, especially when CD4 cell counts are under 200. The World Health Organization reports that TB in HIV-positive people is more likely to be deadly if it goes undiagnosed or is left untreated. TB also occurs earlier in the course of HIV infection than other opportunistic infections.
The Tuberculosis Basics The name “tuberculosis” comes from tubercles, which are small, hard lumps that form when the immune system builds a wall around the TB bacteria in the lungs. TB in the lungs is called
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T Tuberculosis, or TB, is a serious infection that kills more people with HIV worldwide than any other disease. HIV and TB both make each other worse, but there are effective treatments that target these infections. Treatments should be carefully planned. Together with your healthcare provider, you can conquer this infection and continue to lead a long, healthy life with HIV.
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uberculosis (TB) is an opportunistic infection that is caused by bacteria. It usually affects the lungs, but sometimes can affect other organs. TB has become a very serious disease worldwide, with almost a third of the world’s population having the infection. Alarmingly, another third of people living with HIV are infected with TB. A healthy immune system can usually prevent active TB disease, but people with HIV have immune systems that are not as healthy as they should be. TB can be dangerous for those living with HIV, especially when CD4 cell counts are under 200. The World Health Organization reports that TB in HIV-positive people is more likely to be deadly if it goes undiagnosed or is left untreated. TB also occurs earlier in the course of HIV infection than other opportunistic infections.
The Tuberculosis Basics The name “tuberculosis” comes from tubercles, which are small, hard lumps that form when the immune system builds a wall around the TB bacteria in the lungs. TB in the lungs is called
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pulmonary TB. The infection can spread from the lungs to the kidneys, spine, and brain. This is called extrapulmonary TB. This type of TB only shows up in people who have already been infected with TB, but who have not been treated. People with HIV who live in areas where TB is common might develop extrapulmonary TB. Active TB in the lungs can cause coughing for more than several weeks (Table 1). It can also cause weight loss, constant fatigue, night sweats, and fevers, especially in the evening. These are like the symptoms caused by Pneumocystis pneumonia. The symptoms can be different from person to person if TB is in other parts of the body. If people with HIV and TB have unexplained symptoms, they should rule out active TB disease.
TABLE 1
Symptoms of Active TB Disease Symptoms
Feeling tired and/or weak, loss General of appetite, nausea, weight loss, fever and chills, night sweats
Transmission TB is spread when a person with active TB disease coughs, sneezes, or spits. TB particles can also be spread by speaking. Tiny droplets of fluid from the lungs are carried in the air. If other people breathe in these droplets, they can get infected. TB can also pass from a mother to her unborn child before and after birth. However, it’s more common for a baby to catch it after birth due to close contact with its mother.
Cough lasting over 2 weeks, Lungs chest pain, coughing up fluid (sometimes with blood) Spinal cord/ brain (menenges)
Headache, coma
Lymph nodes
Lymph node swelling
Bone marrow Anemia Back/Vertebrae (Pott’s disease)
Back pain, paralysis Source: TheBody.com (www.thebody.com/content/art5055.html).
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pulmonary TB. The infection can spread from the lungs to the kidneys, spine, and brain. This is called extrapulmonary TB. This type of TB only shows up in people who have already been infected with TB, but who have not been treated. People with HIV who live in areas where TB is common might develop extrapulmonary TB. Active TB in the lungs can cause coughing for more than several weeks (Table 1). It can also cause weight loss, constant fatigue, night sweats, and fevers, especially in the evening. These are like the symptoms caused by Pneumocystis pneumonia. The symptoms can be different from person to person if TB is in other parts of the body. If people with HIV and TB have unexplained symptoms, they should rule out active TB disease.
TABLE 1
Symptoms of Active TB Disease Symptoms
Feeling tired and/or weak, loss General of appetite, nausea, weight loss, fever and chills, night sweats
Transmission TB is spread when a person with active TB disease coughs, sneezes, or spits. TB particles can also be spread by speaking. Tiny droplets of fluid from the lungs are carried in the air. If other people breathe in these droplets, they can get infected. TB can also pass from a mother to her unborn child before and after birth. However, it’s more common for a baby to catch it after birth due to close contact with its mother.
Cough lasting over 2 weeks, Lungs chest pain, coughing up fluid (sometimes with blood) Spinal cord/ brain (menenges)
Headache, coma
Lymph nodes
Lymph node swelling
Bone marrow Anemia Back/Vertebrae (Pott’s disease)
Back pain, paralysis Source: TheBody.com (www.thebody.com/content/art5055.html).
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If you or someone you live with has TB, you are all at risk for TB infection. In these cases, TB screening is recommended for the whole family. People who live in close contact with people who have active TB become infected easily. This is especially true if you have advanced HIV.
It’s important for people with HIV to be screened regularly for TB. You can become infected with TB at any CD4 level. Depending on your health and the health of people you live with, TB preventive therapy might be recommended for others in your household. The ultraviolet rays in sunlight can kill TB. Good ventilation also helps because it reduces the risk of TB infection.
TB & HIV: A Bad Pair For many people, TB is the first sign of problems with the immune system that have been linked to HIV infection. Active TB is called an AIDS-defining illness. One in 10 people living with HIV will get active TB within a year of being diagnosed with HIV. It can occur early in HIV disease when CD4 counts are relatively high—in the 300 to 400 range. In early HIV infection, TB usually infects and affects just the lungs. As CD4 counts drop, however, TB is more likely to appear in other bodily organs too. When the immune system responds to TB, it can cause HIV levels to multiply faster. This can lower CD4 counts and make HIV progress more quickly throughout the body. In turn, the risk of other opportunistic infections is increased. This makes it important for people with HIV to prevent and treat TB as soon as it’s detected. The good news is that TB treatment leads to lower HIV levels in some people with both infections.
How a Diagnosis of TB is Made A simple skin test is available to test and see if you have a TB infection. A protein found in TB bacteria is injected into the skin of your arm. If your skin reacts with swelling more than a certain size, you have probably been infected with the TB bacteria. People with HIV should get a TB skin test to find out if they were exposed to TB in the past.
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If you or someone you live with has TB, you are all at risk for TB infection. In these cases, TB screening is recommended for the whole family. People who live in close contact with people who have active TB become infected easily. This is especially true if you have advanced HIV.
It’s important for people with HIV to be screened regularly for TB. You can become infected with TB at any CD4 level. Depending on your health and the health of people you live with, TB preventive therapy might be recommended for others in your household. The ultraviolet rays in sunlight can kill TB. Good ventilation also helps because it reduces the risk of TB infection.
TB & HIV: A Bad Pair For many people, TB is the first sign of problems with the immune system that have been linked to HIV infection. Active TB is called an AIDS-defining illness. One in 10 people living with HIV will get active TB within a year of being diagnosed with HIV. It can occur early in HIV disease when CD4 counts are relatively high—in the 300 to 400 range. In early HIV infection, TB usually infects and affects just the lungs. As CD4 counts drop, however, TB is more likely to appear in other bodily organs too. When the immune system responds to TB, it can cause HIV levels to multiply faster. This can lower CD4 counts and make HIV progress more quickly throughout the body. In turn, the risk of other opportunistic infections is increased. This makes it important for people with HIV to prevent and treat TB as soon as it’s detected. The good news is that TB treatment leads to lower HIV levels in some people with both infections.
How a Diagnosis of TB is Made A simple skin test is available to test and see if you have a TB infection. A protein found in TB bacteria is injected into the skin of your arm. If your skin reacts with swelling more than a certain size, you have probably been infected with the TB bacteria. People with HIV should get a TB skin test to find out if they were exposed to TB in the past.
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If HIV or another disease has damaged your immune system, you might not show any reaction to the skin test. This condition is called anergy. If you have anergy, the most common way to test for TB is a sputum culture. A positive skin test usually doesn’t mean you have active TB. Your healthcare provider will check x-rays of your lungs, ask you about other symptoms, examine samples of your sputum, and try to grow TB bacteria from those samples. They might also try to grow TB from samples taken from other parts of your body where TB can show up. This can take from 2 to 4 weeks, depending on what method is used. It’s difficult to diagnose active TB, especially in people with HIV, because it can look like pneumonia, other lung problems, or other infections. It can also show up outside of the lungs. However, newer, faster tests are being developed. It’s important for people with HIV to be screened regularly for TB. See Table 2 for recommendations on testing for TB. Whether you have TB infection or active TB disease, it’s extremely important to get treated right away. TABLE 2
Testing for TB
Testing for TB is recommended: • To begin when a person is first diagnosed with HIV. • Each year after a person has been diagnosed with HIV. • When starting anti-HIV therapy. • For people with HIV who come into contact with someone with active TB. Source: TheBody.com (www.thebody.com/content/art5055.html).
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Prevent Active TB People with a TB infection can take drugs to help prevent them from developing active TB. People living with HIV are encouraged to consider preventive therapy for TB in the following circumstances: • If TB skin testing has come back positive. • I f there has been contact with someone with active TB disease. • I f it’s determined that a prior episode of TB disease was not treated properly.
One of the most important things that you can do is take precautions to stop the spread of active TB. If you are infected with TB but don’t have the active disease, you should be treated with an antibiotic called isoniazid (INH) for at least 6 months, or with INH plus 1 or 2 other drugs for 3 months. However, INH can cause liver problems, especially for African-American or Hispanic women, so it’s important to be sure that the antibiotic
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If HIV or another disease has damaged your immune system, you might not show any reaction to the skin test. This condition is called anergy. If you have anergy, the most common way to test for TB is a sputum culture. A positive skin test usually doesn’t mean you have active TB. Your healthcare provider will check x-rays of your lungs, ask you about other symptoms, examine samples of your sputum, and try to grow TB bacteria from those samples. They might also try to grow TB from samples taken from other parts of your body where TB can show up. This can take from 2 to 4 weeks, depending on what method is used. It’s difficult to diagnose active TB, especially in people with HIV, because it can look like pneumonia, other lung problems, or other infections. It can also show up outside of the lungs. However, newer, faster tests are being developed. It’s important for people with HIV to be screened regularly for TB. See Table 2 for recommendations on testing for TB. Whether you have TB infection or active TB disease, it’s extremely important to get treated right away. TABLE 2
Testing for TB
Testing for TB is recommended: • To begin when a person is first diagnosed with HIV. • Each year after a person has been diagnosed with HIV. • When starting anti-HIV therapy. • For people with HIV who come into contact with someone with active TB. Source: TheBody.com (www.thebody.com/content/art5055.html).
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Prevent Active TB People with a TB infection can take drugs to help prevent them from developing active TB. People living with HIV are encouraged to consider preventive therapy for TB in the following circumstances: • If TB skin testing has come back positive. • I f there has been contact with someone with active TB disease. • I f it’s determined that a prior episode of TB disease was not treated properly.
One of the most important things that you can do is take precautions to stop the spread of active TB. If you are infected with TB but don’t have the active disease, you should be treated with an antibiotic called isoniazid (INH) for at least 6 months, or with INH plus 1 or 2 other drugs for 3 months. However, INH can cause liver problems, especially for African-American or Hispanic women, so it’s important to be sure that the antibiotic
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is necessary. A recent large study showed that using a once-a-week dose of INH with rifapentine for 3 months was equally effective. Unfortunately, rifapentine interacts with some protease inhibitors, which may or may not be a part of your drug treatment regimen for HIV. Dosage adjustments may be required, but researchers are still learning about how best to do that. It’s important that you check with doctors to make sure that active TB is not present before starting any TB preventive therapy. This is because preventive therapy is less intensive than treatment for active disease. If active TB is present but not yet expressing itself fully, resistance to TB drugs could develop rapidly.
TB (sometimes referred to as MDR-TB) or extensively drug-resistant TB (also known as XDR-TB). These types of TB are much harder to treat. More medications will need to be taken for a longer period of time. Cure rates are lower for MDR-TB and XDR-TB than for regular TB.
Coping With Treatment It can sometimes be difficult to take drugs for both TB and HIV at the same time. Some of the drugs that are used to treat HIV interact poorly with drugs commonly used to fight TB. Anti-HIV therapy requires the use of many pills. Adding anti-TB drugs on top of anti-HIV therapy can be daunting. Some people find it difficult to cope
If you don’t keep taking the medications, the TB in your body might become resistant and the anti-TB drugs will stop working. If you have active TB disease, you will be treated with antibiotics. Because the TB bacteria can develop resistance to individual drugs, you will be given a combination of antibiotics. TB drugs must be taken for at least 6 months. Most cases of TB can be cured with existing antibiotics. But, importantly, if you don’t keep taking the medications, the TB in your body might become resistant and the anti-TB drugs will stop working. There are types of TB that are resistant to some antibiotics. These are called multidrug-resistant
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with taking the large number of pills each day that are required for treating both HIV and TB. Considering this potential problem, TB should usually be cured first before anti-HIV drugs are started. However, this may not be possible if CD4 cell counts are low. The good news is that there are options to explore that might help to make this easier. Talk to your doctor to figure out what treatment plan would work best for you. And no matter what, be sure to adhere to that treatment plan to ensure the best results.
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is necessary. A recent large study showed that using a once-a-week dose of INH with rifapentine for 3 months was equally effective. Unfortunately, rifapentine interacts with some protease inhibitors, which may or may not be a part of your drug treatment regimen for HIV. Dosage adjustments may be required, but researchers are still learning about how best to do that. It’s important that you check with doctors to make sure that active TB is not present before starting any TB preventive therapy. This is because preventive therapy is less intensive than treatment for active disease. If active TB is present but not yet expressing itself fully, resistance to TB drugs could develop rapidly.
TB (sometimes referred to as MDR-TB) or extensively drug-resistant TB (also known as XDR-TB). These types of TB are much harder to treat. More medications will need to be taken for a longer period of time. Cure rates are lower for MDR-TB and XDR-TB than for regular TB.
Coping With Treatment It can sometimes be difficult to take drugs for both TB and HIV at the same time. Some of the drugs that are used to treat HIV interact poorly with drugs commonly used to fight TB. Anti-HIV therapy requires the use of many pills. Adding anti-TB drugs on top of anti-HIV therapy can be daunting. Some people find it difficult to cope
If you don’t keep taking the medications, the TB in your body might become resistant and the anti-TB drugs will stop working. If you have active TB disease, you will be treated with antibiotics. Because the TB bacteria can develop resistance to individual drugs, you will be given a combination of antibiotics. TB drugs must be taken for at least 6 months. Most cases of TB can be cured with existing antibiotics. But, importantly, if you don’t keep taking the medications, the TB in your body might become resistant and the anti-TB drugs will stop working. There are types of TB that are resistant to some antibiotics. These are called multidrug-resistant
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with taking the large number of pills each day that are required for treating both HIV and TB. Considering this potential problem, TB should usually be cured first before anti-HIV drugs are started. However, this may not be possible if CD4 cell counts are low. The good news is that there are options to explore that might help to make this easier. Talk to your doctor to figure out what treatment plan would work best for you. And no matter what, be sure to adhere to that treatment plan to ensure the best results.
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You Can Help Reduce the Spread of TB One of the most important things that you can do is take precautions to stop the spread of active TB. People with active TB are often isolated until they are no longer infectious. This sometimes includes staying in hospital rooms with special airflow called negative airflow. When this happens, air is circulated out of the room, with new air constantly coming in to reduce the risk of TB in the air. Some low-income and residential hotels and shelters are remodeling to include negative airflow devices to help contain the spread of TB. Also, people with active TB can take simple precautions like covering their nose and mouth when coughing or sneezing. Healthcare workers and caretakers can use disposable breathing masks to reduce their risk of spreading TB.
For More Information If you still have questions, the following resources offer more information about tuberculosis and HIV:
Centers for Disease Control and Prevention www.cdc.gov/tb/ publications/pamphlets/ TB&HIV_EN.pdf
TheBody.com www.thebody.com/ index/treat/tubercul.html
World Health Organization www.who.int/hiv/ topics/tb/en/
Joint United Nations Program on AIDS www.unaids.org/en/ strategygoalsby2015/ tuberculosisandhiv/
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You Can Help Reduce the Spread of TB One of the most important things that you can do is take precautions to stop the spread of active TB. People with active TB are often isolated until they are no longer infectious. This sometimes includes staying in hospital rooms with special airflow called negative airflow. When this happens, air is circulated out of the room, with new air constantly coming in to reduce the risk of TB in the air. Some low-income and residential hotels and shelters are remodeling to include negative airflow devices to help contain the spread of TB. Also, people with active TB can take simple precautions like covering their nose and mouth when coughing or sneezing. Healthcare workers and caretakers can use disposable breathing masks to reduce their risk of spreading TB.
For More Information If you still have questions, the following resources offer more information about tuberculosis and HIV:
Centers for Disease Control and Prevention www.cdc.gov/tb/ publications/pamphlets/ TB&HIV_EN.pdf
TheBody.com www.thebody.com/ index/treat/tubercul.html
World Health Organization www.who.int/hiv/ topics/tb/en/
Joint United Nations Program on AIDS www.unaids.org/en/ strategygoalsby2015/ tuberculosisandhiv/
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