HIV-associated tuberculosis: diagnostic and treatment challenges.

Tuberculosis (TB) and the human immunodeficiency virus (HIV) are, individually, two of the world's greatest ongoing public health threats. In combination, the two diseases can be even more devastating. HIV significantly increases an individual's chances of reactivation of latent TB infection and progression to active TB disease. HIV's associated immunosuppression makes it more difficult to diagnose active TB due to a higher likelihood of atypical and extrapulmonary presentation and poorer performance of standard diagnostic tools. TB is the major cause of death in individuals infected with HIV, and the combination of both illnesses creates unique treatment challenges for providers due to interactions between antituberculous and antiretroviral medications, overlapping drug toxicities, and the immune reconstitution inflammatory syndrome. Magnifying these challenges even further is the fact that much of the burden of TB/HIV coinfection exists in some of the world's most resource-limited settings. Concerted efforts are needed to identify rapid and accurate diagnostic tools for active TB disease and latent TB infection (LTBI) that are practical and inexpensive and that perform well in individuals with HIV infection. Also needed are effective and feasible strategies to optimize management of both conditions in the coinfected patient.