Bedrohung durch die HIV/Tuberkulose-Koinfektion

Globally 15% of TB patients are also infected with HIV. The highest rates of coinfection are found in the developing world and in the countries of the former Soviet Union. Active TB can occur in all stages of HIV infection; the clinical presentation depends on the grade of immunodeficiency. The diagnosis of latent TB infection (LTBI) is difficult if cellular immunity is severely impaired. In cases with negative sputum smears bronchoscopy should be performed. Nontuberculous mycobacterioses should be ruled out. During the treatment of TB, interactions with concomitantly given antiretrovirals should be taken into consideration. The duration of TB treatment may be frequently prolonged to prevent relapse. The risk of the immune reconstitution syndrome is increased when treatment of both infections is started simultaneously. The incidence of active tuberculosis in HIV-positive persons can be reduced by preventive treatment of LTBI. Vice versa timely initiation of antiretroviral therapy considerably decreases the risk of TB.