HIV and Tuberculosis
- All people with HIV should be tested for TB infection as soon as possible after they get an HIV diagnosis.
- Anyone who has TB disease, is being evaluated for TB disease, or is a contact of a TB patient should be tested for HIV.
Tuberculosis, or TB, is caused by the bacterium Mycobacterium tuberculosis. TB is spread through the air from one person to another. Not everyone infected with TB bacteria gets sick. Some people develop TB disease soon after infection; many others keep the infection in their bodies without getting sick (called latent TB infection). A small proportion of people with latent TB infection may develop TB disease in the future. Thus, two TB-related conditions exist: latent TB infection and active TB disease.
- People with latent TB infection are not sick, do not have symptoms, and cannot spread TB bacteria.
- People with TB disease are sick, have symptoms, and can spread the bacteria to others.
People with newly diagnosed HIV should be tested for TB infection even if they have no signs or symptoms of TB disease. People with HIV who have an ongoing risk for TB exposure should be tested every year. The risk for exposure to TB is the same for everyone: being in close contact with someone with infectious TB disease. The risk of developing TB disease after infection is higher for some people, especially for people with HIV who are not on treatment for HIV.
Several recommended treatment regimens are available for latent TB infection.
CDC. Reported Tuberculosis in the United States, 2017. Accessed January 31, 2019.
Unfortunately, some people with HIV do not know they have latent TB infection. Similarly, some people with TB disease do not know their HIV status.
How to Address Treatment and Prevention Challenges
- People who do not know they have HIV or TB cannot take advantage of treatment. Anyone who has recently received an HIV or TB disease diagnosis should be tested for coinfection. Without treatment, each disease makes the other disease more severe. TB disease is considered an “AIDS-defining condition.” When a person with HIV gets TB, they are diagnosed with AIDS, the most advanced stage of HIV. Worldwide, TB is a leading cause of death among people with HIV.
- Possible drug interactions can make it difficult to manage HIV-related TB. One concern is the interaction of rifamycins (a group of drugs often used to treat latent TB infection and TB disease) with certain medicines used to treat HIV. People who have both HIV and TB should seek care from health care providers with expertise in the management of both diseases.
- Drug-resistant TB can develop when a TB patient is not treated with the right drugs or does not take the drugs the right way. This means that the drug can no longer kill the TB bacteria. TB that is resistant to drugs is harder to treat and can lead to death. To prevent the continued emergence of drug-resistant strains, treatment for TB disease must be improved, not only in the United States but worldwide.
- Following a treatment plan may be hard for people who have HIV and TB. People with HIV and TB disease should start treatment for TB as soon as possible, finish the medicine, and take the drugs exactly as prescribed. Health care providers should prescribe shorter regimens when possible. Patients are more likely to finish shorter treatment regimens. The most effective way to ensure that patients complete their TB treatment is through the use of patient-centered care, which may include supervision of treatment (known as “directly observed therapy” or DOT).
What CDC Is Doing
- Assessing new TB diagnostic techniques;
- Supporting health departments and community-based organizations to include integrated screening for TB, HIV, and other infections within their comprehensive HIV prevention efforts;
- Developing new TB treatment regimens that are effective for people with HIV, and compatible with diverse HIV treatment regimens;
- Increasing the capacity of health professionals to provide adequate patient care by offering training and promoting evidence-based guidelines; and
- Continuing to address and support global TB control.
- For more information, visit www.cdc.gov/tb. To learn what CDC is doing to prevent HIV, visit www.cdc.gov/hiv.
- Reported Tuberculosis in the United States, 2017.
- Recommendations for Human Immunodeficiency Virus (HIV) screening in Tuberculosis (TB) clinicspdf icon (fact sheet).
- Estimated HIV incidence and prevalence in the United States, 2010-2016pdf icon. HIV Surveillance Supplemental Report 2019;24(1).
- Tuberculosis—United States, 2018. MMWR 2019;68(11);257-262
- Core Curriculum on Tuberculosis: What the Clinician Should Knowpdf icon. Accessed May 30, 2019.
- Mortality among patients with Tuberculosis and associations with HIV status—United States, 1993–2008. MMWR 2010;59(46):1509-13.
- Plan to combat extensively drug-resistant Tuberculosis: Recommendations of the Federal Tuberculosis Task Force. MMWR 2009;58(3):1-43.
- Borisov AS, Bamrah Morris S, Njie GJ, et al. Update of recommendations for use of once-weekly isoniazid-rifapentine regimen to treat latent mycobacterium tuberculosis infection. MMWR 2018;67(25):723-6. PubMed abstractexternal icon.
- Panel on opportunistic infections in HIV-Infected adults and adolescents. guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the centers for disease control and prevention, the national institutes of health, and the HIV medicine association of the infectious diseases society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdfpdf iconexternal icon. Accessed April 16, 2019.
- Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS. Isoniazid-rifapentine for latent tuberculosis infection: A systematic review and meta-analysis. Am J Prev Med 2018;55(2):244-52. PubMed abstractexternal icon.
- World Health Organization. HIV-associated Tuberculosispdf iconexternal icon (fact sheet). Accessed March 20, 2018.