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Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-infected patients

Madhukar Pai, MD, PhD
Dick Menzies, MD, MSc
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Approximately one-third of the world’s population is estimated to be latently infected with Mycobacterium tuberculosis, representing a major reservoir of potential active disease [1]. The intersection of the HIV and tuberculosis (TB) epidemics has led to a major upsurge in TB cases, particularly in resource-limited settings where TB is prevalent [2,3]. However, the risk of active TB disease in HIV-infected patients can be reduced with preventive therapy, thus emphasizing the importance of appropriate diagnostic and therapeutic interventions for latent tuberculosis infection (LTBI) [4-6].

This topic will address the diagnosis of LTBI in the HIV-infected patient. Treatment of LTBI in the HIV-infected host is discussed in detail elsewhere. (See "Treatment of latent tuberculosis infection in HIV-infected adults".)

Diagnostic testing for LTBI in the HIV-uninfected host is discussed elsewhere. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults".)


What is latent tuberculosis? — Tuberculosis (TB) infection is caused by inhalation of viable bacilli, which usually persist in an inactive state, known as latent TB infection (LTBI), or sometimes progress rapidly to active TB disease. Persons with LTBI are asymptomatic and not infectious. However, these latent TB bacilli remain viable and may “reactivate” years later and cause active symptomatic, and often transmissible, TB disease [7].

HIV as a risk factor for active tuberculosis — Concomitant infection with HIV is a leading risk factor for progression from LTBI to active disease [8,9]. In nonendemic areas, the rate of progression to active TB disease is 5 to 8 percent/year among HIV-infected patients with LTBI, compared with a 10 percent lifetime risk in the general population [10]. In resource-limited settings, where TB is the leading cause of death, the risk of reactivation is in the range of 10 percent per year [11,12]. Hence, prevention of active TB disease is a high priority in HIV care [5]. (See "Treatment of latent tuberculosis infection in HIV-infected adults", section on 'Risk factors for progression'.)


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Literature review current through: Sep 2016. | This topic last updated: Mar 14, 2016.
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