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Tuberculosis and HIV/AIDS

December 9, 2015

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Tuberculosis and HIV/AIDS

Table of Contents


Tuberculosis (TB) is an infection of the lungs and respiratory system, which is the organ system that allows us to breathe. One third of the world's people are infected with TB, and along with HIV, TB is one of the world's leading causes of death due to disease. The World Health Organization (WHO) estimates that over three million women became sick with TB in 2014. Of the 9.6 million new cases of tuberculosis in 2014, over one million occurred in people living with HIV (HIV+). The risk of developing TB is estimated to be 26 to 31 times greater for people living with HIV than for those who are HIV-negative. The largest numbers of TB infection occur in south-east Asia (58 percent of global total), while over one quarter of the 9.6 million occurred in Africa.

In the US, the number of new TB cases reported each year has been going down since 1993. According to the Centers for Disease Control and Prevention (CDC), the number of TB cases reported in 2014 was the lowest that is has been since reporting began in 1953.

TB is caused by a bacterium called Mycobacterium tuberculosis. It spreads from person to person when an infected person coughs, sneezes, laughs, or spits. Tiny droplets of fluid from the lungs are carried in the air and can be breathed in by someone nearby. Although it can affect many parts of the body, TB usually occurs in the lungs.

Forms of TB

Not everyone who is infected with TB bacteria shows signs of TB infection or develops "active" disease.

  • Latent TB - Most people with healthy immune systems can fight off TB bacteria, even after they breathe them in and are infected. This is called latent TB, which means it is inactive. People with latent or inactive TB are infected with TB yet have no symptoms. They do not feel sick and cannot spread the disease to other people. In some people, TB stays latent or inactive for their entire lives. But in other people, latent TB turns into active disease if their immune system is damaged or weakened, through things like HIV infection, cancer, or transplant surgery that requires taking drugs to suppress the immune system.
  • Active TB - Some people infected with TB develop active disease. Active TB usually causes symptoms like coughing and weight loss. People with active TB can spread it to others. Active TB may develop either soon after infection or years later when a person's immune system becomes weaker.

TB and HIV

People with weakened immune systems are more likely to develop active TB disease. This includes people living with HIV, children, elderly people, and people who take drugs that suppress the immune system. Research shows that, among those with latent TB, people living with HIV are three to 12 times more likely to develop active TB disease than HIV-negative people. Treating latent TB can greatly reduce your chances of developing active TB. Treatment of latent TB protects your health as well as keeps you from spreading TB to others. You can develop active TB with any CD4 count. Studies also show that TB can worsen HIV disease progression.

Worldwide, TB is the leading cause of death in people living with HIV in Africa, and a leading cause of death elsewhere. The WHO estimates that one third of the 35 million people living with HIV worldwide are infected with TB. The CDC recommends that people living with HIV be screened for TB when they are first diagnosed with HIV; in addition, yearly screening is recommended for people living with HIV who have repeated exposure to others with active TB (see "Diagnosing TB," below).

Preventing TB

TB is spread through the air when an infected person coughs, sneezes or spits. Family members of people with TB, people living in the same house, health-care workers, and people who live in residential facilities like homeless shelters and prisons are most likely to get TB. People with latent (not active) TB do not spread the disease. Once a person with active TB starts treatment (see "TB Treatment" below), they usually cannot spread the disease after two to three weeks on treatment.

People with active TB should be separated from others until they can no longer spread the disease. If you have TB or spend time around people with TB, it is important to wear a disposable face mask. Certain types of air filters can trap the TB bacteria, and ultraviolet light can kill it.

TB Symptoms

After TB bacteria are inhaled, they settle in the lungs. People with healthy immune systems can usually fight the bacteria and keep it from multiplying. The immune system may build structures that wall off or contain the bacteria. These structures can burst, leaving scars in the lungs. If a person's immune system is too weak and the structures burst, the bacteria can get out and enter the bloodstream. Once in the bloodstream they travel to other parts of the body including the brain, kidneys, bones, and reproductive organs, where they can cause infertility. This is called "extrapulmonary TB" because is has spread outside the lungs. Extrapulmonary TB is more likely in people with advanced HIV disease.

People with active TB disease may develop symptoms including:

  • Cough lasting more than two to three weeks
  • Coughing up sputum (phlegm) or blood
  • Unexplained weight loss
  • Fever or chills
  • Night sweats
  • Fatigue (unusual tiredness)
  • Loss of appetite
  • Chest pain
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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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