Impact of HIV on TB

Clinical description

• High HIV prevalence is associated with an increase in the number of new TB cases. HIV

infection increases susceptibility to new TB infections and accelerates the progression from LTBI to active TB disease. HIV is associated with an increase in smear-negative and EPTB cases.

• HIV infection increases TB-associated morbidity and mortality. HIV-positive TB

patients have a higher case-fatality during TB treatment compared with HIV-negative patients. HIV-positive, smear-negative patients and EPTB patients have worse treatment outcomes than smear-positive TB patients. Adverse reactions to anti-TB drugs are more frequent in PLHIV compared to the general population, leading to interruptions of treatment and poor outcomes.

• TB recurrence rates are higher in HIV-positive patients than in HIV-negative patients.

Recurrence of TB may be from reactivation of persistent organisms not killed by previous anti-TB treatment or re-infection due to re-exposure to another infectious person.

• MDR-TB has been reported amongst patients with HIV in Malawi. HIV does not cause

MDR-TB, but it can increase the spread of this condition by increasing susceptibility to infection and accelerating the progression from infection to disease.