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Treatment of latent tuberculosis infection in HIV-infected adults

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


Human immunodeficiency virus (HIV) infection has had a profound impact on the epidemiology, clinical manifestations, and outcome of tuberculosis (TB) [1,2]. The intersection of these two epidemics has been associated with a major surge in TB cases, particularly in resource-limited settings [3-5]. The World Health Organization (WHO) estimates that 13 percent of deaths among patients with acquired immune deficiency syndrome (AIDS) worldwide are related to TB [6]. The impact of HIV on TB disease is particularly notable in sub-Saharan Africa, where the incidence of TB increased between 1990 to 2005 from approximately 150 to over 400 per 100,000 population [4,5,7,8].

Issues related to prevention of active TB disease through treatment of latent tuberculosis infection (LTBI) in the HIV-infected patient will be reviewed here. The diagnosis of LTBI in the HIV-infected patient and treatment of active TB disease are discussed separately. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-infected patients" and "Treatment of pulmonary tuberculosis in HIV-infected adults".)


Tuberculosis (TB) infection is caused by inhalation of viable tuberculous bacilli; these organisms usually persist in an inactive state, known as latent TB infection (LTBI); in some cases following inhalation, there is rapid progression to active TB disease. Individuals with LTBI are asymptomatic and not infectious. Latent TB bacilli remain viable and may reactivate years later, causing active symptomatic and transmissible TB disease [9].

The natural history of tuberculosis is discussed further separately. (See "Natural history, microbiology, and pathogenesis of tuberculosis".)

Risk factors for progression — Risk factors for progression to active TB disease include [10-13]:


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