TB and HIV Coinfection
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What can HIV/AIDS Service Organizations Do to Help?
- Collaborate with your local health department’s tuberculosis
(TB) control program.
- Educate your staff and clients about TB.
- Educate your staff and clients about the importance of TB testing in the
prevention of TB
HIV-Related TB Can Be Prevented and Treated – and You Can Help!
Many people think tuberculosis (TB) is a disease of the past. However,
in spite of fewer people in this country suffering with TB, it remains
a serious threat, especially for HIV-infected persons. In fact,
worldwide TB is one of the leading causes of death among people
infected with HIV. As someone working in an AIDS service
organization (ASO), you can play a critical role in ensuring that
HIV-related TB can be prevented and treated in your clients.
What is Tuberculosis (TB)?
TB is a disease caused by the bacterium called Mycobacterium tuberculosis.
This disease primarily affects the lungs, but can attack any organ
in the body. TB is spread through the air from one person to another.
The bacteria are put into the air when a person with TB disease
of the lungs or throat coughs or sneezes. People nearby may breathe
in these bacteria and become infected. However, not everyone infected
with TB bacteria becomes sick. As a result, two TB-related conditions
exist: latent TB infection and active TB disease.
Both of these conditions are treatable.
What is the difference between latent TB infection and active
In most people who breathe in TB bacteria and become infected,
the body is able to fight the bacteria and stop them from growing.
The bacteria become inactive, but they remain alive in the body
and can become active later. This is called latent TB infection.
There are an estimated 9 to 14 million persons in the United States
infected with TB bacteria. Most people who have latent
TB infection never develop active TB disease. In these people, the
TB bacteria remain inactive for a lifetime without causing disease.
A person with latent TB infection does not feel sick and
cannot spread TB bacteria to others.
However, TB bacteria can become active if the immune
system can’t stop them from growing. These bacteria begin to multiply
in the body and cause active TB disease. Because HIV weakens
the immune system, people with latent TB infection and HIV infection
are at very high risk of developing active TB disease.
People with latent TB infection
- Have TB bacteria in their body that are alive, but inactive
- Do not feel sick
- Cannot spread TB bacteria to others
- Usually have a positive TB skin test or QFT-G test
- Will have a normal chest x-ray
- May become sick if the bacteria become active in their body
- Need treatment for latent TB infection as soon as possible
to prevent them from developing active TB disease
People with active TB disease
- Have active TB bacteria in their body
- Feel sick and may experience symptoms such as fever, weight
loss, and a bad cough that lasts 3 weeks or longer
- May spread TB bacteria to others
- Usually have a positive TB skin test or QFT-G test
- May have an abnormal chest x-ray
- Can die from this life-threatening disease if undiagnosed
- Need treatment with multiple medications to treat active TB
How do you get tested for TB?
There are two tests that can be used to help detect TB infection
- the TB skin test and the QuantiFERON®-TB Gold (QFT-G) test.
The TB skin test is performed by injecting a
small amount of testing material into the upper layers of the skin on the
inside of the forearm. The person getting the test must return two
to three days later to have the test site on the arm examined by
a trained health care worker. If there is a reaction (a raised,
swollen area) on the arm, the size of
the reaction is measured. A positive reaction means that the
person probably has TB infection. Some people who are infected with
both HIV and TB will not react to the TB skin test. This is because
the immune system is not working properly. Another test for TB
infection, the QFT-G test, is a blood test that measures how the
patient’s immune system reacts to the germs that cause TB.
A positive TB skin test or QFT-G test only tells that a person
has been infected with TB germs. It does not tell whether or not the
person has progressed to active TB disease. Other tests, such as a
chest x-ray and a sample of sputum, are needed to see whether the
person has TB disease.
All HIV-infected people should get a TB test to find
out if they have TB infection.
To find out where TB skin tests are offered in your community or
to determine if your organization should provide TB testing services,
contact your state or local health department’s TB control program.
Why should I be concerned about TB and HIV coinfection?
- Without treatment, as with any other opportunistic infection,
HIV and TB can work together to shorten the life of the person
- Someone with untreated latent TB infection and
HIV infection is much more likely to develop active TB
disease during his or her lifetime than someone without HIV infection.
- Among people with latent TB infection, HIV infection is the
strongest known risk factor for progressing to active TB disease.
- A person who has both HIV infection and active TB disease has an AIDS-defining
The good news is that HIV-infected persons with either latent TB
infection or active TB disease can be effectively treated. The first
step is to ensure that HIV-infected persons get a test for TB
any other needed tests. The second step is to help the people found
to have either latent TB infection or active TB disease get proper
treatment. Rapid progression from latent TB infection to active
TB disease can easily be prevented. And active TB disease can be treated
in HIV-infected persons.
There are a number of treatment options for HIV-infected persons
with either latent TB infection or active TB disease. For the latest
guidelines on treatment regimens, refer to the
resources listed on the back of this brochure, and also consult
with your state or local health department. It is important for
HIV-infected patients to be closely monitored by a physician during
any type of treatment to make sure they are not hurt by side effects
from taking TB and HIV medicines together. Monitoring is also important
to ensure the TB medicines are not interacting with patients’
HIV medicines in a way that could alter the effect.
The medicine usually used to treat latent TB infection:
Taken as prescribed, INH will kill the TB bacteria in the body
and prevent the development of active TB disease.
Multiple medicines are used to treat active TB
- Isoniazid (INH)
- Rifampin or Rifabutin
To treat active TB disease, several different medicines are needed.
This is because there are many bacteria to be killed. Taking several
drugs will do a better job of killing all of the bacteria and preventing
them from becoming resistant to the drugs.
A crucial component of treating active TB disease is directly observed
therapy (DOT). With DOT, a health worker watches the patient swallow
each dose of TB medication. DOT increases patient adherence and
prevents relapses, continued transmission of infection to others, and the development of
drug resistance. If resources are available, DOT may also be beneficial
for the treatment of latent TB infection, especially in HIV-infected
persons. To find out if your organization can help with DOT services,
please contact your state or local health department’s TB control
How can your organization help prevent HIV-related TB in your
Collaborate with your state or local health department’s TB control
- Educate your staff and clients about TB
- Educate your staff and clients about testing for TB
- Educate your staff about the proper treatment of persons coinfected
with TB and HIV
Other ways your organization may be able to help:
- Provide TB testing for your high-risk clients
- Assist in the delivery of DOT for latent TB infection
CDC publications about TB for your health care providers:
CDC Publications about TB for your clients:
For more information, the following resources are also available:
Or contact your state or local health department
Last Modified: 07/8/2008
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention