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Epidemiology, clinical manifestations, and diagnosis of tuberculosis in HIV-infected patients

Gary Maartens, MBChB, MMed
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


The intersection of the HIV and tuberculosis (TB) epidemics resulted in a dramatic upsurge in global TB incidence, which peaked around 2005. The greatest burden of HIV-associated TB is borne by sub-Saharan Africa [1].

In high income countries, all forms of TB are regarded as AIDS-defining conditions [2]. In contrast, the World Health Organization (WHO) staging system, used in most low-middle income countries, separates pulmonary TB (stage 3) from extrapulmonary TB (stage 4 or AIDS) [3]. Since TB commonly occurs in immunocompetent people, it is not surprising that TB occurs with a wide range of CD4 counts. The CD4 count determines the incidence as well as the clinical and radiographic presentations of TB [4,5].

The epidemiology, clinical features, and diagnosis of TB in HIV-infected patients will be reviewed here. Prophylaxis and treatment of this disorder are discussed separately. (See "Treatment of latent tuberculosis infection in HIV-infected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults: Initiation of therapy".)


The World Health Organization (WHO) estimated 9 million new tuberculosis (TB) cases in 2013, 1.1 million of whom were HIV infected with 360,000 deaths [6]. Among people with HIV, the global incidence of new TB cases has declined marginally since 2005, while deaths have declined from a peak of just over 500,000 in 2004 to 320,000 in 2012, largely due to increasing access to antiretroviral therapy (ART). The 2013 estimated incidence of TB by country and the prevalence of HIV in TB cases by country are summarized in the Figures (figure 1 and figure 2). A large proportion of the global burden of HIV-associated TB occurs in sub-Saharan Africa, with 79 percent of new cases of TB and 83 percent of deaths. The burden is particularly high in southern Africa, where some countries have annual TB incidence rates exceeding 1000 per 100,000 population.

Interactions between HIV and tuberculosis — Dual infection with HIV and TB leads to reciprocal interactions that have significant clinical impact.

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Literature review current through: Oct 2017. | This topic last updated: Dec 14, 2016.
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