Video:HIV/TB coinfection
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Description
The co-epidemic of tuberculosis and human immunodeficiency virus is one of the major global health challenges in the present time. The World Health Organization reports 9 (point) 2 million new cases of TB in 2006 of whom 7 (point) 7 percent were HIV-infected.[1] Tuberculosis is the most common contagious infection in HIV-Immunocompromised patients leading to death.[2]

Presentation
The combined symptoms in HIV-TB coinfection include but are not limited to the following: severe weight loss , severe respiratory symptoms and fatigue.[3][4]

Complication
Immune reconstitution inflammatory syndrome (IRIS) can be a complication of HIV-TB coinfection. IRIS occurs when the immune system begins to recover due to antiretroviral therapy in HIV-infected individuals, leading to an exaggerated inflammatory response against existing infections, including tuberculosis.[5][6]

Cause 1
Mycobacterium tuberculosis is the most common cause of Tuberculosis disease . Airborne transmission typically causes TB infection in both immunocompetent and immunocompromised hosts.[7]

Cause 2
The human immunodeficiency viruses are two species of Lentivirus that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS),[8][9] a condition in which progressive failure of the immune system allows life-threatening opportunistic infections to thrive.[10]

Pathogenesis
HIV-TB infection is a bi-directional interaction of the two pathogens.[11]TB disease appears when the immune response is unable to stop the growth of mycobacteria. The cytokine interferon gamma plays a pivotal role in signaling of the immune system during infection. Reduced production of interferon gamma or its cellular receptors lead to severe and fatal TB.[12]During HIV infection, interferon gamma production is decreased dramatically which leads to an increased risk of developing reactivation or reinfection by M. tuberculosis in these HIV-TB patients.[12]TB may also influence HIV evolution. Proinflammatory cytokine production by tuberculous granulomas has been associated with increased HIV viraemia, which might accelerate the course of disease.[13]

Diagnosis
In terms of diagnosis once it has been established HIV is present and prior to start of antiretroviral therapy the WHO advises TB screening. Among the possible methods are: chest x-ray, sputum smear microscopy, culture of Mycobacterium tuberculosis, NAAT, and tuberculin skin test.[14]Conversely, in those with tuberculosis testing for HIV is recommended.[15]

Prevention
When HIV-negative children take isoniazid after they have been exposed to tuberculosis, their risk to contract tuberculosis is reduced.[16] A Cochrane review investigated whether giving isoniazid to HIV-positive children can help to prevent this vulnerable group from getting tuberculosis. They included three trials conducted in South Africa and Botswana and found that isoniazid given to all children diagnosed with HIV may reduce the risk of active tuberculosis and death in children who are not on antiretroviral treatment.[17][18]
Treatment 1
It is currently recommended that HIV-infected individuals with TB receive combined treatment for both diseases, irrespective of CD4+ cell count. ART along with ATT is the only available treatment in present time.[19] [18] Though the timing of starting ART is the debatable question due to the risk of immune reconstitution inflammatory syndrome . The advantages of early ART include reduction in early mortality, reduction in relapses, preventing drug resistance to ATT and reduction in occurrence of HIV-associated infections other than TB.[20]The disadvantages include cumulative toxicity of ART and ATT, drug interactions leading to inflammatory reactions are the limiting factors for choosing the combination of ATT and ART.[21]

Treatment 2
A systematic review investigated the optimal timing of starting antiretroviral therapy in adults with newly diagnosed pulmonary tuberculosis.[22]The review authors included eight trials, that were generally well-conducted, with over 4500 patients in total. The early provision of antiretroviral therapy in HIV-infected adults with newly diagnosed tuberculosis improved survival in patients who had a low CD4 count. However, such therapy doubled the risk for IRIS. [22]Regarding patients with higher CD4 counts, the evidence is not sufficient to make a conclusion about benefits or risks of early antiretroviral therapy.[22]

Treatment 3
In terms of the management of HIV/Multidrug-resistant tuberculosis we find anti-TB treatment involves second-line drugs, which have more side effects than first-line drugs used for drug-susceptible TB. Additionally, there are more significant drug-drug interactions because of use of second-line anti-TB drugs, requiring careful dose adjustments.[23][24][25]

Treatment 4
As to HIV/Extensively drug-resistant tuberculosis it is resistant to the most effective first-line and second-line medications, therefore, treatment becomes more complicated than HIV/MDRTB coinfection. Immune system due to HIV makes it harder to treat TB, and the drug resistance limits the available treatment options. Bedaquiline and delamanid, might be used.[26]

Epidemiology 1
In terms of the epidemiology of HIV-TB coinfection we find that it is a significant global health problem. In 2021, there were about 7 (point) 5 million new TB cases worldwide, with six hundred thirty thousand individuals co-infected with HIV. As a risk factor HIV infection, increases the risk of latent TB reactivation by 20-fold.[27][28][29]TB is the primary cause of death among individuals living with HIV.Tuberculosis accounts for one-quarter of AIDS-related deaths around the world.[27]

Epidemiology 2
As to prevalence we find that HIV-TB co-infection varies across the world, from 2 (point) 93 percent to 72 (point) 34 percent. The following prevalence rates are per region or continent: african countries: 31 (point) 25 percent, asian countries: 17(point) 21 percent, european countries: 20 (point) 11 percent, latin american countries: 25 (point) 06 percent and north america countries : 14 (point) 84 percent.[30]

History
In terms of the history of HIV-TB coinfection we find that a study by researchers at Linköping University, Sweden indicated how HIV virus affects the immune system, making it easier for the tuberculosis bacterium to progress to active disease. The discovery helped explain why HIV-positive individuals are at a higher risk of developing active TB.[31][32]

References
- ↑ World Health Organization (2012). Global Tuberculosis Report 2012 (PDF). World Health Organization. ISBN 978-92-4-156450-2. Archived (PDF) from the original on 2018-04-12. Retrieved 2022-07-08.
- ↑ World Health Organization (1999). "Tuberculosis infection control in the era of expanding HIV care and treatment" (PDF). Archived (PDF) from the original on 2017-11-18. Retrieved 2022-07-08.
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(help) - ↑ STOICA (CĂLĂRAŞU), CRISTINA; POPA (MIULESCU), ALINA MARINELA; TURCU, ADINA ANDREEA; NITU, FLOAREA MIMI (11 March 2021). "The Profile of the Patients with Double Infection HIV and TB in South West of Romania". Current Health Sciences Journal. 47 (1): 107–113. doi:10.12865/CHSJ.47.01.17. PMC 8200610. PMID 34211756.
- ↑ "HIV and Tuberculosis (TB) | NIH". hivinfo.nih.gov. Retrieved 6 January 2025.
- ↑ Shankar, Esaki Muthu; Vignesh, Ramachandran; Murugavel, Kailapuri G; Balakrishnan, Pachamuthu; Sekar, Ramalingam; Lloyd, Charmaine AC; Solomon, Suniti; Kumarasamy, Nagalingeswaran (December 2007). "Immune reconstitution inflammatory syndrome in association with HIV/AIDS and tuberculosis: Views over hidden possibilities". AIDS Research and Therapy. 4 (1): 29. doi:10.1186/1742-6405-4-29. PMC 2216023. PMID 18053126.
- ↑ "Treatment of tuberculosis in patients with HIV coinfection" (PDF). Queensland health. Retrieved 3 January 2025.
- ↑ "Tuberculosis (TB)". www.who.int. Archived from the original on 2020-07-30. Retrieved 2024-12-29.
- ↑ Weiss RA (May 1993). "How does HIV cause AIDS?". Science. 260 (5112): 1273–9. Bibcode:1993Sci...260.1273W. doi:10.1126/science.8493571. PMID 8493571.
- ↑ Douek DC, Roederer M, Koup RA (2009). "Emerging Concepts in the Immunopathogenesis of AIDS". Annual Review of Medicine. 60: 471–84. doi:10.1146/annurev.med.60.041807.123549. PMC 2716400. PMID 18947296.
- ↑ Powell MK, Benková K, Selinger P, Dogoši M, Kinkorová Luňáčková I, Koutníková H, Laštíková J, Roubíčková A, Špůrková Z, Laclová L, Eis V, Šach J, Heneberg P (2016). "Opportunistic Infections in HIV-Infected Patients Differ Strongly in Frequencies and Spectra between Patients with Low CD4+ Cell Counts Examined Postmortem and Compensated Patients Examined Antemortem Irrespective of the HAART Era". PLOS ONE. 11 (9): e0162704. Bibcode:2016PLoSO..1162704P. doi:10.1371/journal.pone.0162704. PMC 5017746. PMID 27611681.
- ↑ Yusuf Aliyu, Anna; Adeleke, Oluwatoyin A. (2024). "Latest Progress on Tuberculosis and HIV Co-Infection: A Closer Look at People of Different Ages". Advanced Therapeutics. n/a (n/a): 2400033. doi:10.1002/adtp.202400033. ISSN 2366-3987.
- ↑ 12.0 12.1 Ottenhoff, Tom H.M; Kumararatne, Dinakantha; Casanova, Jean-Laurent (November 1998). "Novel human immunodeficiencies reveal the essential role of type-1 cytokines in immunity to intracellular bacteria". Immunology Today. 19 (11): 491–494. doi:10.1016/S0167-5699(98)01321-8. PMID 9818540.
- ↑ Garrait, V; Cadranel, J; Esvant, H; Herry, I; Morinet, P; Mayaud, C; IsraelBiet, D (September 1997). "Tuberculosis generates a microenvironment enhancing the productive infection of local lymphocytes by HIV". Journal of Immunology. 159 (6): 2824–2830. doi:10.4049/jimmunol.159.6.2824. PMID 9300705. Archived from the original on 11 September 2022. Retrieved 7 December 2015.
- ↑ Swaminathan, Soumya; Padmapriyadarsini, C; Narendran, G (2011). "Diagnosis & treatment of tuberculosis in HIV co-infected patients". The Indian Journal of Medical Research. 134 (6): 850–865. doi:10.4103/0971-5916.92630. ISSN 0971-5916. PMC 3284094. PMID 22310818.
- ↑ "GUIDANCE ON PROVIDER-INITIATED HIV TESTING AND COUNSELLING IN HEALTH FACILITIES" (PDF). WHO. Archived (PDF) from the original on 27 November 2023. Retrieved 27 December 2024.
- ↑ Smieja, M. J.; Marchettu, C. A.; Cook, D. J.; Smaill, F. M. (1999). "Isoniazid for preventing tuberculosis in non-HIV infected persons". Cochrane Database of Systematic Reviews (2): CD001363. doi:10.1002/14651858.CD001363. PMC 6532737. PMID 10796642.
- ↑ Zunza, M.; Gray, D. M.; Young, T.; Cotton, M.; Zar, H. J. (2017). "Isoniazid for preventing tuberculosis in HIV-infected children". Cochrane Database of Systematic Reviews. 2017 (8): CD006418. doi:10.1002/14651858.CD006418.pub3. PMC 5618450. PMID 28850172.
- ↑ 18.0 18.1 "Co-management of HIV and active TB disease". Treatment of Tuberculosis: Guidelines. 4th edition. World Health Organization. 2010.
- ↑ Clinical trial number NCT00933790 for "Comparing Daily vs Intermittent Regimen of ATT in HIV With Pulmonary Tuberculosis" at ClinicalTrials.gov
- ↑ Lawn, Stephen D; Harries, Anthony D; Anglaret, Xavier; Myer, Landon; Wood, Robin (October 2008). "Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa" (PDF). AIDS. 22 (15): 1897–1908. doi:10.1097/qad.0b013e32830007cd. ISSN 0269-9370. PMC 3816249. PMID 18784453. Archived (PDF) from the original on 2017-08-19. Retrieved 2022-07-08.
- ↑ Kapoor, Gauri; Singh, Neha (2018). "Role of apoptotic markers in paediatric acute lymphoblastic leukaemia". Indian Journal of Medical Research. 147 (3): 225–227. doi:10.4103/ijmr.ijmr_906_17. ISSN 0971-5916. PMC 6022391. PMID 29923509.
- ↑ 22.0 22.1 22.2 Uthman, Olalekan A.; Okwundu, Charles; Gbenga, Kayode; Volmink, Jimmy; Dowdy, David; Zumla, Alimuddin; Nachega, Jean B. (7 July 2015). "Optimal Timing of Antiretroviral Therapy Initiation for HIV-Infected Adults With Newly Diagnosed Pulmonary Tuberculosis". Annals of Internal Medicine. 163 (1): 32–9. doi:10.7326/M14-2979. PMID 26148280. S2CID 207538325.
- ↑ Navasardyan, Inesa; Miwalian, Rita; Petrosyan, Aelita; Yeganyan, Stephanie; Venketaraman, Vishwanath (21 February 2024). "HIV-TB Coinfection: Current Therapeutic Approaches and Drug Interactions". Viruses. 16 (3): 321. doi:10.3390/v16030321. ISSN 1999-4915. Archived from the original on 26 July 2024. Retrieved 18 December 2024.
- ↑ Sultana, Zeeba Zahra; Hoque, Farhana Ul; Beyene, Joseph; Akhlak-Ul-Islam, Md.; Khan, Md Hasinur Rahman; Ahmed, Shakil; Hawlader, Delwer Hossain; Hossain, Ahmed (11 January 2021). "HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis". BMC Infectious Diseases. 21 (1): 51. doi:10.1186/s12879-020-05749-2. ISSN 1471-2334. Retrieved 5 January 2025.
- ↑ Rendon, Adrian; Tiberi, Simon; Scardigli, Anna; D’Ambrosio, Lia; Centis, Rosella; Caminero, Jose A.; Migliori, Giovanni Battista (October 2016). "Classification of drugs to treat multidrug-resistant tuberculosis (MDR-TB): evidence and perspectives". Journal of Thoracic Disease. 8 (10): 2666–2671. doi:10.21037/jtd.2016.10.14. Retrieved 5 January 2025.
- ↑ Migliori, Giovanni Battista; Pontali, Emanuele; Sotgiu, Giovanni; Centis, Rosella; D'Ambrosio, Lia; Tiberi, Simon; Tadolini, Marina; Esposito, Susanna (7 February 2017). "Combined Use of Delamanid and Bedaquiline to Treat Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis: A Systematic Review". International Journal of Molecular Sciences. 18 (2): 341. doi:10.3390/ijms18020341. ISSN 1422-0067. Retrieved 5 January 2025.
- ↑ 27.0 27.1 Pawlowski, Andrzej; Jansson, Marianne; Sköld, Markus; Rottenberg, Martin E.; Källenius, Gunilla (16 February 2012). "Tuberculosis and HIV Co-Infection". PLOS Pathogens. 8 (2): e1002464. doi:10.1371/journal.ppat.1002464. ISSN 1553-7374. PMC 3280977. PMID 22363214.
- ↑ Zhang, Shun-Xian; Wang, Ji-Chun; Yang, Jian; Lv, Shan; Duan, Lei; Lu, Yan; Tian, Li-Guang; Chen, Mu-Xin; Liu, Qin; Wei, Fan-Na; Feng, Xin-Yu; Yang, Guo-Bing; Li, Yong-Jun; Wang, Yu; Hu, Xiao-Jie; Yang, Ming; Lu, Zhen-Hui; Zhang, Shao-Yan; Li, Shi-Zhu; Zheng, Jin-Xin (16 August 2024). "Epidemiological features and temporal trends of the co-infection between HIV and tuberculosis, 1990-2021: findings from the Global Burden of Disease Study 2021". Infectious Diseases of Poverty. 13 (1): 59. doi:10.1186/s40249-024-01230-3. ISSN 2049-9957. PMC 11328430. PMID 39152514.
- ↑ "The path that ends AIDS". UNAIDS. Archived from the original on 4 October 2024. Retrieved 24 December 2024.
- ↑ Gao, Junling; Zheng, Pinpin; Fu, Hua (31 May 2013). "Prevalence of TB/HIV Co-Infection in Countries Except China: A Systematic Review and Meta-Analysis". PLOS ONE. 8 (5): e64915. Bibcode:2013PLoSO...864915G. doi:10.1371/journal.pone.0064915. PMC 3669088. PMID 23741419.
- ↑ "Tuberculosis and HIV co-infection". ScienceDaily. Archived from the original on 4 April 2019. Retrieved 26 December 2024.
- ↑ Singh, Susmita K.; Andersson, Anna-Maria; Ellegård, Rada; Lindestam Arlehamn, Cecilia S.; Sette, Alessandro; Larsson, Marie; Stendahl, Olle; Blomgran, Robert (December 2016). "HIV Interferes with Mycobacterium tuberculosis Antigen Presentation in Human Dendritic Cells". The American Journal of Pathology. 186 (12): 3083–3093. doi:10.1016/j.ajpath.2016.08.003. PMID 27746182. Archived from the original on 2022-08-09. Retrieved 2024-12-26.