Tuberculosis

Tuberculosis and HIV

Tuberculosis (TB) is a disease that is caused by a specific type of bacterial infection called Mycobacterium tuberculosis. TB usually affects the lungs, but it can also affect the brain, kidneys, spine or other organ systems. TB can cause serious health problems, including death, if left untreated.

According to the Centers for Disease Control and Prevention (CDC), fewer people in the U.S. have TB disease than in past years. However, despite a decrease in reported TB cases, the disease remains a serious threat, especially for people living with HIV/AIDS. That’s because TB infection and HIV infection can work together to make you very sick. Worldwide, TB is the leading cause of death among people living with HIV.

TB is an issue for people living with HIV/AIDS in the U.S. because:

• It is estimated that about 4.2% of Americans (13 million individuals) are infected with TB bacteria.
• As of 2011, CDC estimated 6% of all TB cases and 10% of TB cases among people aged 25–44 occurred among people who were HIV-positive.

Because of the serious health risks for coinfection with TB and HIV, the CDC recommends that all HIV-positive people should be tested for TB. Those who test positive for TB should begin treatment immediately.

For more information, see CDC’s TB and HIV/AIDS.

How TB is Spread

TB is primarily an airborne disease. When a person with active TB disease coughs, sneezes, speaks, or sings, TB germs spread through the air. These germs can float in the air for several hours. If you breathe in the air containing these TB germs, you can become infected.

TB is NOT spread by:

• Shaking someone’s hand
• Sharing food or drink
• Touching bed linens or toilet seats
• Sharing toothbrushes
• Kissing

For more information, see CDC’s Get the Facts about TB Disease.

Two Types of TB Infection

There are two types of TB infection latent and active. People with latent TB infection (LTBI) don’t have any signs or symptoms of the disease and don’t feel sick. They are not infectious and cannot spread TB infection to others. However, these people could develop TB disease in the future, especially if they have HIV infection. That’s because people with TB infection and HIV infection have a very high risk of developing TB disease. Fortunately, people with LTBI can take medicine to prevent them from developing active, severe TB disease.

When people are clinically ill with TB, they are said to have “active” TB disease. People with active TB disease can spread the illness to others. Medicines which can cure TB are usually given to these people.

For more information, see CDC’s Tuberculosis: The Connection Between TB and HIV. 

Symptoms

Symptoms of TB can vary from person to person. People who have LTBI will have no symptoms. People with active TB infection can experience persistent coughing (including coughing up blood), night sweats, fever, weight loss, chills, and fatigue. If you are experiencing any of these symptoms, you should consult your healthcare provider right way.

Testing

There are two types of tests to determine if you have TB infection—a skin test and a blood test.

You can get a skin test at the health department or at your doctor's office. A healthcare worker will use a small needle inject some testing fluid (called tuberculin) just under the skin on the lower part of your arm. After 2–3 days, you must return to have your skin test checked by a healthcare worker. A “positive” reaction usually means that you have TB infection.

There are also tests that use a small amount of your blood to check for TB. The advantage of the blood test is that only one visit is required to draw blood for the test and you don’t have to wait 2–3 days for the result. However, not all healthcare providers offer these tests.

A positive TB skin test or TB blood test can only show that you have been infected with TB bacteria. It does not tell whether or not you have progressed to TB disease. You will need to take other tests, such as a chest x-ray, and give a sample of sputum, to see whether you have TB disease and whether the strain of TB is drug-resistant. These tests will help you and your healthcare provider choose the best course of treatment.

For more information, see CDC’s Tuberculosis: Questions and Answers About TB.

How Often Should I Be Tested?

In general, CDC recommends that all people who are newly diagnosed with HIV infection should be tested for TB as soon as possible. In addition, people living with HIV and at risk for TB exposure should be tested annually to find out if they have LTBI.  You should also be retested for TB if you are just beginning antiretroviral therapy for your HIV disease.

For additional TB testing guidelines, see CDC’s Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.

Treatment

There are a number of treatment options for people living with HIV who have either LTBI or active TB disease. Treatment consists of long-term (9–12 months) antibiotic therapy for both LTBI and active disease. If you are taking antiretrovirals for your HIV disease, the treatment period may be even longer.

Treatment for TB can be as challenging as treatment for HIV. There are some risks involved, mainly because the treatments can cause liver damage in some people. If you have both HIV and TB, it is important to be closely monitored by a healthcare provider during your treatment to make sure you are not hurt by side effects from taking TB and HIV medicines together.

Also, if you begin antibiotic therapy for TB, it’s important to take ALL your medication, on time and in the way your healthcare provider recommends. Like HIV, TB can become resistant to medications quickly if you miss doses of your meds.

For more information, see CDC’s National Prevention Information Network: TB and HIV Coinfection.

Drug-Resistant TB

Unfortunately, some strains of TB bacteria have stopped responding to medications regularly used to treat TB disease. Drug resistance is more common in people who:

• Do not take their TB medicine regularly
• Do not take all of their TB medicine as directed by their healthcare provider
• Develop active TB disease again, after having taken TB medicine in the past
• Come from areas of the world where drug-resistant TB is common
• Have spent time with someone known to have drug-resistant TB disease

Multidrug-resistant TB (MDR TB) is TB that is resistant to at least two of the best anti-TB drugs—isoniazid and rifampin. MDR TB is extremely difficult to treat and can be fatal.

Although the number of cases in the United States remained steady since 1998, MDR TB has now been reported in nearly all states and the District of Columbia.

Extensively Drug-Resistant Tuberculosis (XDR TB) is resistant to the most powerful first-line and second-line drugs. Patients with XDR TB have fewer, less-effective treatment options and often have worse treatment outcomes.

People living with HIV infection or with AIDS are at greater risk of dying of MDR TB and XDR TB. For more information, see CDC’s Fact Sheet: Multidrug-Resistant Tuberculosis (MDR TB), and Fact Sheet: Extensively Drug-Resistant Tuberculosis (XDR TB).