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Clin Infect Dis. 2010 May 15;50(10):1377-86. doi: 10.1086/652147.

HIV-associated tuberculosis: clinical update.

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Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India.


The human immunodeficiency virus (HIV) epidemic has led to an increase in the incidence of tuberculosis globally, particularly in sub-Saharan Africa. Coinfection with HIV leads to difficulties in both the diagnosis and treatment of tuberculosis. Because of the poor performance of sputum smear microscopy in HIV-infected patients, more sensitive tests-such as liquid culture systems, nucleic acid amplification assays, and detection of mycobacterial products in various body fluids-are being investigated. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs to be administered concomitantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution syndrome. Both multidrug-resistant and extensively drug-resistant tuberculosis can spread rapidly among an immunocompromised population, with resulting high mortality rates. Current guidelines recommend starting antiretroviral treatment within a few weeks of antituberculosis therapy for patients with CD4 cell counts <350 cells/microL; however, important questions about the drug regimens and timing of antiretroviral therapy remain. Ongoing trials may answer many of these unresolved questions.

[Indexed for MEDLINE]

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