Tuberculosis (pulmonary and extrapulmonary) often can be the initial clinical manifestation of immunodeficiency and is considered an AIDS-defining illness. HIV infection increases the risk of reactivation disease and the likelihood that initial infection will result in active disease. 7 The incidence of tuberculosis in HIV-infected patients varies according to community prevalence, but is much higher than in the general population. Physicians considering a diagnosis of tuberculosis should offer patients HIV testing, which may provide early diagnosis and therapy.
Pulmonary involvement may be difficult to distinguish from other HIV-associated lung disorders. Tuberculosis must be in the differential of any HIV-associated respiratory disorder and can present atypically on chest radiographs. The incidence of extrapulmonary tuberculosis is higher in patients diagnosed with AIDS (greater than 70 percent) and in those with less advanced HIV infection (24 to 45 percent) than in individuals not infected with HIV. 7 The most common forms of extrapulmonary disease are lymphadenitis and miliary disease.7
Treatment of tuberculosis in coinfected individuals is generally effective, but some reports have indicated higher mortality rates in coinfected patients. 7 The incidence of adverse drug reactions to antituberculosis chemotherapy is higher in HIV-infected than in HIV-negative patients. 8 Due to the number of medications taken by patients with HIV, potential drug interactions must also be of concern.
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