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HIV and Tuberculosis

  • All people with newly diagnosed HIV should be tested for TB infection as soon as possible.
  • 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 becomes sick. 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.

All people with newly diagnosed HIV should be tested for TB infection as soon as possible, even if they have no signs or symptoms of TB disease. People with HIV and at ongoing risk for TB exposure should be tested annually. 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 exposure is higher for some people, especially for people with HIV.

People with HIV and latent TB infection need treatment for HIV and for latent TB infection as soon as possible to prevent them from developing TB disease. Taking TB medicines is the only way to kill the TB germs in the body. Without treatment, the risk of developing TB disease is 100 times higher for people with latent TB infection who have HIV compared to people without HIV. TB outbreaks can rapidly expand in patient groups infected with HIV.

Several recommended treatment regimens are available for latent TB infection.

Unfortunately, some people with HIV do not know they are infected with TB. Similarly, some people with TB disease are unaware of their HIV status.

HIV Coinfection Among People With TB Disease
and a Documented HIV Test, by Year

This chart shows HIV coinfection among people with TB disease and a documented HIV test from 1993 to 2016. There were 2,633 people with TB disease and HIV infection in 1993; 2,523 in 1994; 2,063 in 1995; 1,757 in 1996; 1,407 in 1997; 1,194 in 1998; 1,125 in 1999; 917 in 2000; 892 in 2001; 822 in 2002; 786 in 2003; 655 in 2004; 598 in 2005; 546 in 2006; 467 in 2007; 399 in 2008; 384 in 2009; 311 in 2010;331 in 2011; 328 in 2012; 258 in 2013; 230 in 2014; 205 in 2015; 229 in 2016.

CDC. Reported Tuberculosis in the United States, 2016. Accessed March 20, 2018.

The Numbers

  • At the end of 2015, an estimated 1,122,900 adults and adolescents in the United States were living with HIV, 15% of whom did not know they were infected.
  • A total of 9,272 TB cases (a rate of 2.9 cases per 100,000 persons) were reported in the United States in 2016.
  • In 2016, 90% of patients with TB disease knew their HIV status.
  • Among 8,150 persons with TB disease who had a documented HIV test result in 2016, 6% (454) were coinfected with HIV.
  • From 1993 to 2016, the estimated percentage of HIV coinfection in persons with TB who had a documented HIV test result decreased from 48% to 6%.
  • In the United States, up to 13 million people may have latent TB infection.

Prevention Challenges

  • Lack of awareness of TB or HIV status can prevent adequate treatment. Anyone who has recently received an HIV or TB diagnosis should be tested for coinfection. Without treatment, each disease increases the severity of the other. TB disease is an AIDS-defining condition. 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 living with 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.
  • Adhering to treatment may be difficult for people living with 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 the shorter regimens, when possible. Patients are more likely to finish shorter treatment regimens. The most effective way to ensure that patients finish their TB treatment is directly observed therapy.

What CDC Is Doing

CDC and its domestic and international partners are taking many steps to prevent the further spread of TB and to reduce the overall burden of the disease in the United States and around the world. Efforts include:

  • Assessing new TB diagnostic techniques;
  • Developing new TB treatment regimens for people with HIV;
  • 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/hiv or www.cdc.gov/tb.

Bibliography

  1. CDC. Reported Tuberculosis in the United States, 2016.
  2. CDC. Recommendations for Human Immunodeficiency Virus (HIV) screening in Tuberculosis (TB) clinics (fact sheet).
  3. CDC. Estimated HIV incidence and prevalence in the United States, 2010-2015. HIV Surveillance Supplemental Report 2018;23(1).
  4. CDC. Tuberculosis Trends—United States, 2014. MMWR 2015;64(10);265-88.
  5. CDC. Mortality among patients with Tuberculosis and associations with HIV status—United States, 1993–2008. MMWR 2010;59(46):1509-13.
  6. CDC. Plan to combat extensively drug-resistant Tuberculosis: Recommendations of the Federal Tuberculosis Task Force. MMWR 2009;58(3):1-43.
  7. 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 abstract.
  8. Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR 2009;58(RR-4):1-207. PubMed abstract.
  9. 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 abstract.
  10. Stewart RJ, Tsang CA, Pratt RH, Price SF, Langer AJ. Tuberculosis—United States, 2017. MMWR 2018;67(11):317-23. PubMed abstract.
  11. World Health Organization. HIV-associated Tuberculosis (fact sheet). Accessed March 20, 2018.

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