Question | Discussion | References | CME Credit

Updated January 22, 2011

Case 4: Latent Tuberculosis Infection

Author: Ingrid A. Binswanger, MD, MPH

A 40-year-old HIV-infected man with a CD4 count of 337 cells/mm3 is taking active antiretroviral therapy and has an undetectable HIV RNA level. He presents for routine follow-up and currently is asymptomatic. He states that his partner, whom he is living with, was recently diagnosed with active pulmonary tuberculosis (TB) and is currently undergoing treatment for TB.

Regarding the exposure to his partner, which of the following statements describes appropriate subsequent management of this 40-year-old HIV-infected man?

A After excluding active TB with a symptom review and a chest radiograph, you should treat him with 9 months of isoniazid (INH).
B You should ask him about current symptoms that would suggest active TB and obtain a chest radiograph. If his chest radiograph is negative, he does not require further treatment.
C You should discontinue his antiretroviral therapy and start him on four-drug TB treatment.
D You should test for latent TB infection with a tuberculin skin test and for anergy with a mumps control. If, 50 hours later, he has 0 mm of induration for both of the tests, you should inform him he does not require further treatment.