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Updated September 14, 2012

Initial Management of Newly Diagnosed HIV Infection and Active Tuberculosis: anti-Tuberculosis Therapy

Authors: Getachew Feleke, MD Eskinder Tesfaye, MD Manuel Kassaye, MD Christopher Behrens, MD

A 28-year-old Ethiopian woman presents to Urgent Care with a 2-month history of fever, night sweats, weight loss, and cough. Her physician suspects tuberculosis and orders sputum smears and HIV testing. She is diagnosed with HIV infection and pulmonary tuberculosis on the basis of a positive HIV serology result, chest radiograph findings (Figure 1), and a sputum smear that reveals acid-fast bacilli (Figure 2). She has no evidence of extrapulmonary TB and has never been treated for TB before. Her absolute CD4 count is 100 cells/mm3; an HIV viral load is not available.

Which of the following would you recommend regarding the management of this patient?

A Given the high prevalence of drug resistance among patients co-infected with TB and HIV, anti-TB therapy should not be started until drug susceptibilities are known for her strain of TB.
B Anti-tuberculosis therapy should be started immediately, consisting of a four-drug regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol.
C The duration of therapy for this HIV-infected patient with pulmonary TB should be 18 months.
D Rapid HIV serology test result should be confirmed prior to initiation of anti-TB therapy, since she will need different medications to treat her pulmonary TB therapy if she is co-infected with HIV.

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    Figure 1. Chest Radiographic of an HIV-infected patient with active TB

    Radiographic changes in the lower lung fields of a patient co-infected with HIV and TB.
    Courtesy of Dr. Desalew Mekonnen from the University of Gondar in Ethiopia


    Figure 1
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    Figure 2. Sputum smear from an HIV-infected patient with active TB

    Mycobacterium tuberculosis bacilli (in red) in a sputum sample obtained from a patient with active pulmonary tuberculosis
    Courtesy of Dr. Desalew Mekonnen from the University of Gondar in Ethiopia


    Figure 2