Tuberculosis and HIV potx
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Tuberculosis and HIV
VCHAP
Vietnam-CDC-Harvard Medical School
AIDS Partnership
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Learning Objectives
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Outline of Talk
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TB/HIV co-infection: HIV prevalence
among TB patients in some provinces
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Incidence of Active TB in Persons with
Positive Tuberculin Skin Test
Am J Resp Crit Care Med 2000 Apr;161 (4 Pt 2 ): S221-47
Risk Factor TB Cases/1000
person-years
TB infection < 1 year ago 12.9
TB infection 1-7 years ago 1.6
HIV/AIDS 35 – 162
HIV + Injection Drug User 76
HIV – Injection Drug User 10
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OI distribution in 100 HIV/AIDS patients at
Tropical Disease Hospital (HCMC) - 2000
Oral thrush
Tuberculosis
Wasting syndrome*
Respiratory infections
Cryptococcosis
Penicilliosis
PCP
Septicemia
53%
37%
34%
13%
9%
7%
5%
4%
Louie JK, Nguyen HC et al. Inter Jrnl of STD & AIDS 2004;15:758 - 761
*50% of pts with this diagnosis, grew + cultures for MTB
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OI distribution in 220 HIV/AIDS inpatients at
NIITD (Hanoi) 2001-2002
Oral thrush 43 %
Wasting syndrome 33%
Tuberculosis 28%
Penicilliosis 11%
Shingles 5%
Septicemia 5%
Cerebral toxoplasmosis 3%
MAC infection 3%
PCP 2%
Leishmaniasis 0,5%
Aspergillosis 0,5%
Le Dang Ha et al.2001-2002
Clinical Presentation of the
PLWHA with Tuberculosis
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The effect of HIV infection on signs
and symptoms of TB
Symptom/sign HIV positive (%)
HIV negative (%)
Dyspnea
Fever
Sweats
Weight loss
Diarrhea
Hepatomegaly
Splenomegaly
Lymphadenopathy
97
79
83
89
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35
81
62
64
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Chest 1994;106:1471-6
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Clinical presentation and CD4
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cough with or without bloody sputum
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upper lobe disease, cavitations
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pleural effusions
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fever, weight loss etc
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Clinical presentation and CD4
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fever, weight loss with minimal cough
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AIDS wasting syndrome
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extrapulmonary disease
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atypical chest radiographs
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smear negative tuberculosis
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Sputum smear and HIV status
Tubercle Lung Dis 1993;75:191-4
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Chest XRAY findings in patients with TB/HIV
Early stages of HIV (CD4 > 500)
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infiltrates predominantly in upper lobes
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pulmonary cavities present
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pleural effusions
Advanced stages of HIV (CD4 < 200)
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pulmonary cavities absent
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infiltrates in middle and lower lobes
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nodular infiltrates
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effusions can be pleural and pericardial
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mediastinal lymphadenopathy with no
pulmonary infiltrates
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normal CXR
Diagnosing Tuberculosis in
the PLWHA
WHO 2006 Case Definitions for
Tuberculosis
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New Perspectives on the Case Definition of
Tuberculosis
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2006 WHO case definition
Smear positive pulmonary TB (SPPTB)
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Non-HIV settings HIV prevalent settings-NEW
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2006 WHO case definition
Smear negative pulmonary TB (SNPTB)
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Non-HIV settings HIV prevalent settings-NEW
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2006 WHO case definition
Extrapulmonary TB (EPTB)
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HIV prevalent settings-NEWNon-HIV settings
Evaluation and Management of the
PLWHA suspected to have
Tuberculosis
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New WHO Perspectives on the Evaluation and
Management of the PLWHA suspected to have TB
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Adult HIV prevalence rate among pregnant women is ≥1% or HIV
prevalence among TB patients is ≥5%.
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Setting : country, sub-national administration unit (e.g., district, county),
selected facility (e.g., referral hospital, drug rehabilitation centre)
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Key WHO recommendations in 2006
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Key WHO recommendations in 2006
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HIV staging (clinical , immunological)
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PCP treatment
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Co-trimoxazole preventive therapy
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Key 2006 WHO Recommendations for Smear negative
TB (SNPTB) and/or Extrapulmonary TB (EPTB):
“THE ANTIBIOTIC TRIAL”
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