The document discusses the interaction between tuberculosis (TB) and HIV on epidemiological, clinical, and cellular levels. It notes that HIV is the strongest risk factor for reactivation of latent TB infection. Co-infection increases morbidity and mortality as HIV increases the risk of developing active TB disease. A coordinated public health approach is needed that includes intensified case finding, infection control, and isoniazid prophylaxis to address the synergistic relationship between TB and HIV.

1. Anna Grinsted

2.  Overview of TB and HIV
 Evidence of interaction
 Epidemiological, clinical and cellular levels
 Implications
 Conclusions

3.  Mycobacterium tuberculosis
 2 billion people - roughly one-third
of the world population - are
infected
 Primary infection most commonly
respiratory
 Typical presentation = Productive
cough, weight loss, fever, night
sweats, fatigue, loss of appetite.
 Transmitted by respiratory droplets
 Infectious dose = 1-10 bacilli
 Destructive effects entirely due to
hypersensitivity reaction of host

4. • Over 40 million people are
infected worldwide
• 3 million deaths/yr
• HIV-1 (and HIV-2)
• enveloped RNA Retrovirus
• Transmission: sexual, blood-
borne, perinatal.

5. Worldwide TB Incidence (2009)
25% of deaths of people
living with HIV are
attributed to TB
In Africa:
50% of those with HIV
develop TB,
80% with TB are HIV positive

6. Co-infection increases
morbidity and
mortality
Lifetime TB risk in
immunocompetent
persons is 5-10%,
but in HIV +ve
individuals, the
annual TB risk is 5-
15%
HIV is the most powerful
known risk factor for
reactivation of
Latent to active TB

7. Reduced
generation time
IL-1beta IL-6 IL-8 GMCSF
...enhances viral replication
synergistic reduction in
macrophage viability
Macrophage

8.  DOTS = Directly Observed Therapy, Short course
 HAART
 3 I’s strategy—
 Intensified case finding,
 Infection control,
 Isoniazid antibiotic prophylaxis

9. All people living with HIV should be evaluated for
TB at the time of initial HIV diagnosis and during follow-up.
HIV testing should be considered in new cases of TB.
 Co-ordination of services
 Multidisciplinary approach
 Research
 How to combine services
 Diagnostic tests for TB in the immunocomprimised
 How to combine treatment
 Prophylaxis

10.  High index of suspicion
 Difficult diagnosis in immunocompromised
 Infection Control
 Don’t wait for a positive culture to isolate!
 Drug Resistance
 DR-TB, MDR-TB, XDR-TB

11. See TB ---- think HIV
See HIV --- think TB!
• TB and HIV interact on many levels and act in
synergy, resulting in increased morbidity and
mortality
• There are considerations for both the individual
and for public health
•There are implications for clinical practice and
research
• A co-ordinated approach is required

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 Pictures available from:
 medicineworld.org, kashmirnewz.com, http://www.labgrab.com/users/labgrab/blog/you-can-see-lot-just-looking-yogi-berra_id=884,
http://gamapserver.who.int/mapLibrary/Files/Maps/HIVPrevalenceGlobal2006.png,
http://gamapserver.who.int/mapLibrary/Files/Maps/TBincidence_2009.png