How is tuberculosis affected by HIV infection and AIDS?

  • Increasing numbers of adults and children have both HIV infection and untreated tuberculosis. As adults are highly infectious, more infants (both HIV positive and negative) are becoming infected with TB bacilli.
  • HIV infection weakens the immune system. This increases the risk that the child will develop severe tuberculosis. Previous asymptomatic primary tuberculous infection may become reactivated resulting in tuberculosis. With damage to the immune system by HIV, previously well controlled TB bacilli can become active and multiply rapidly.
  • Tuberculosis may be the first serious infection in an HIV infected child and be the first indication that the child is HIV infected.

HIV infection weakens the immune system and allows previously dormant tuberculosis bacilli to become active, resulting in tuberculosis.

  • Due to their weak immune system, tuberculosis of organs other than the lungs is more common in children with HIV infection, e.g. miliary tuberculosis or tuberculous meningitis and even chronic otitis media due to TB bacilli.
  • The recent increase in deaths due to tuberculosis in many developing countries is largely due to the spread of HIV infection. Tuberculosis is a very common complication of HIV infection and many children with HIV infection will develop pulmonary tuberculosis. Co-infection (TB and HIV) is a major problem in South Africa.
  • Most children with both HIV and tuberculous infections will respond as well to the standard antituberculosis treatment as children who are not infected with HIV.

Tuberculosis is a very common complication and cause of death in children and adults with HIV infection.

HIV infection makes the diagnosis of TB more difficult. The Mantoux skin test may be falsely negative and the chest X-ray confusing. While a smear may be negative, TB bacilli can still be grown in the sputum.

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