Tuberculosis

Suman Majumdar, Philipp du Cros  Burnet Institute and Department of Infectious Diseases, Alfred Hospital, Melbourne VIC Last reviewed: October 2019 Introduction Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis and is an acquired immune deficiency syndrome (AIDS)-defining illness in Australia and other high-income countries. TB remains a global health crisis with an …

Mycobacterium tuberculosis infection in people with HIV infection Read More »

HIV co-infection is the most powerful known risk factor for progression of LTBI to active disease. The risk of progression from LTBI to active TB in people with HIV infection is approximately 5 to 8% per year, in contrast to a 10% lifetime risk in HIV-negative people.[1] HIV has an impact on the host-pathogen (M. …

HIV/TB co-infection Read More »

Active tuberculosis The optimal diagnosis of active TB involves early and accurate bacteriological confirmation in order to confirm M. tuberculosis infection and to detect potential anti-mycobacterial drug-resistance at baseline. Early diagnosis of HIV-associated TB can be difficult due to the non-specific clinical symptoms, inadequate diagnostic tools available and failure to consider it in the differential …

Diagnosis Read More »

The management of active TB-HIV co-infection involves prompt initiation of an appropriate multidrug TB regimen that is guided by DST, commencing cART and treatment monitoring. The ASHM Antiretroviral Guidelines, an Australian handbook and several international guidelines include a more complete discussion of the diagnosis and treatment of TB in patients with HIV infection. TB can be a …

Management of active tuberculosis Read More »

TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) occurs in two forms, unmasking and paradoxical. Case definitions have been published for resource-limited settings. Disease pathogenesis mechanisms are similar for both forms of TB-IRIS and reflect restoration of an immune response against M. tuberculosis after administration of cART that results in an exaggerated inflammatory response to live or …

TB-associated immune reconstitution inflammatory syndrome Read More »

Close collaboration among clinicians, health-care institutions and public health programs involved in the diagnosis and treatment of patients with HIV infection and TB is necessary in order to integrate care and improve patient outcomes. A specialist or specialists with appropriate expertise should supervise the management of all patients with HIV-TB co-infection in Australia. Hospital admission …

Treatment delivery and monitoring Read More »

Treatment of LTBI to prevent the development of active TB is called preventive treatment (PT; previously prophylaxis) and is often commenced irrespective of confirmed LTBI diagnosis and based on risk of LTBI. Preventive treatment can reduce the progression of LTBI to active TB in people with HIV infection by 32-62% and reduces the risk of …

Treatment of latent tuberculosis infection (preventive treatment) Read More »

World Health Organization. Global tuberculosis report 2018. Geneva: WHO; 2018. Available at: https://www.who.int/tb/publications/global_report/en/ Majumdar SS, Marais BJ, Denholm JT, Britton WJ. Drug-resistant tuberculosis: collaborative regional leadership required. Med J Aust 2014;200:241–2. Toms C, Stapledon R, Douglas P, National Tuberculosis Advisory Committee, for the Communicable Diseases Network Australia, Australian Mycobacterium Reference Laboratory Network, (null), et al. …

References Read More »