HIV and Tuberculosis

image of lungs with TB
    All people with HIV should be tested for TB infection as soon as possible after they get an HIV diagnosis.
image of tb virus in a patient
    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.

 

image of man coughing
  • 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.

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.

This chart shows HIV coinfection among people with TB disease and a documented HIV test from 1993 to 2016. There were 3,466 people with TB disease and HIV infection in 1993; 3,403 in 1994; 2,869 in 1995; 2,461 in 1996; 1,999 in 1997; 1,755 in 1998; 1,658 in 1999; 1,398 in 2000; 1,369 in 2001; 1,344 in 2002; 1,280 in 2003; 1,150 in 2004; 1,017 in 2005; 927 in 2006; 845 in 2007; 792 in 2008; 687 in 2009; 596 in 2010; 649 in 2011; 611 in 2012; 536 in 2013; 491 in 2014; 456 in 2015; 454 in 2016; 439 in 2017.

CDC. Reported Tuberculosis in the United States, 2017. Accessed January 31, 2019.

The Numbers

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.

know the facts about HIV and TB

 

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

 

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

  1. Reported Tuberculosis in the United States, 2017.
  2. Recommendations for Human Immunodeficiency Virus (HIV) screening in Tuberculosis (TB) clinicspdf icon (fact sheet).
  3. Estimated HIV incidence and prevalence in the United States, 2010-2016pdf icon. HIV Surveillance Supplemental Report 2019;24(1).
  4. Tuberculosis—United States, 2018. MMWR 2019;68(11);257-262
  5. Core Curriculum on Tuberculosis: What the Clinician Should Knowpdf icon. Accessed May 30, 2019.
  6. Mortality among patients with Tuberculosis and associations with HIV status—United States, 1993–2008. MMWR 2010;59(46):1509-13.
  7. Plan to combat extensively drug-resistant Tuberculosis: Recommendations of the Federal Tuberculosis Task Force. MMWR 2009;58(3):1-43.
  8. 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.
  9. 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.
  10. 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.
  11. World Health Organization. HIV-associated Tuberculosispdf iconexternal icon (fact sheet). Accessed March 20, 2018.