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HIV and tuberculosis (TB) co-infection

Tuberculosis (TB) is one of the most common co-infections that people with HIV can get. 

It’s passed on through the air, in the coughs and sneezes of someone with active TB. 

If you have HIV and TB, you can cure the TB with antibiotics, and treat the HIV with antiretrovirals. 

What is TB?

Tuberculosis (TB) is a bacteria. It can infect your lungs or throat (pulmonary TB). It can also infect other parts of your body (extra-pulmonary TB), such as your lymph nodes, spine or brain. 

What is HIV and TB co-infection?

This is when you have HIV and TB at the same time.  

What are the symptoms of TB?

Symptoms of active TB (when you feel sick) include: 

  • a cough with sputum (mucus) or blood for more than 3 weeks 

  • chest pain 

  • extreme tiredness 

  • fever 

  • night sweats 

  • loss of appetite 

  • weight loss. 

Symptoms of active extra-pulmonary TB often include swollen glands or pain in the affected area. 

Latent (or inactive) TB does not have symptoms or health problems. But, latent TB can become active and you may develop symptoms if this happens. 

How do you get TB?

To get TB you usually need to spend a lot of time in close contact with someone with active TB.  

TB is passed on through the air when a person who is actively infected with TB coughs, sneezes, or exhales. Bacteria comes from their mouth in tiny droplets which you can then breathe in. 

How do you prevent TB?

It's difficult to prevent TB because it can be passed on through the air. If you have HIV and someone you live with or have a lot of close contact with has active TB, you should speak to a healthcare professional. The most effective way to prevent TB is to get tested and treated for latent TB before it becomes active TB.  

If you have TB, cover your mouth with your hand or a tissue when you cough or sneeze to help to stop the spread of TB. 

How do you test for TB?

People with HIV should test for TB regularly. There are many types of TB tests:  

  • a blood test – this is the most common test 

  • testing a sample of sputum (the mucus that is coughed up) or another body fluid 

  • injecting a small amount of TB protein under your skin to see if there's a reaction  

  • a chest x-ray, to see if TB has scarred your lungs. 

How do you treat TB?

Active TB can almost always be cured with antibiotics. For pulmonary TB, antibiotics are usually taken daily for six months. For people with TB in other parts of their body, treatment will last longer, perhaps up to 24 months. 

Latent TB can be treated with preventative treatment to stop it turning into active TB. This is always necessary for people with HIV to prevent TB causing illness and to cure it. It will be a similar course of treatment to active TB. 

It’s important that you take all the pills you are given. If you don’t, TB becomes resistant to the drugs, and is much harder to treat. 

Is there a vaccine for TB?

Yes, the bacille Calmette-Guérin (BCG) vaccine can protect against serious illness from TB. It is around 80% effective against the most severe types of TB. In countries where TB is common, the BCG is given to infants and small children as part of the national childhood immunisation programme.

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Is TB more serious for people with HIV?

People with HIV and TB can find that the TB: 

  • is harder to diagnose 

  • spreads faster / can spread to other parts of the body 

  • is more likely to be fatal if left untreated 

  • is more likely to return after being treated 

  • is harder to treat if you have a drug-resistant strain. 

Why is TB more common in people with HIV?

When someone is exposed to TB, their immune system is usually able to fight the infection and they don’t get sick. But people with weak immune systems – such as people with HIV who are not on effective treatment – can’t fight the bacteria, so it can multiply and make them very sick. 

If you have HIV, it means that: 

  • you’re more likely to develop TB if your immune system is weakened 

  • you can reduce the risk of TB by taking your HIV treatment correctly to keep your immune system strong and healthy 

  • you should test regularly for TB. 

What’s the difference between active TB and latent TB?

Active TB is when you feel sick and latent TB is when you feel well. 

Active TB is also called TB disease. It’s when the bacteria that causes TB is ‘alive’ and multiplying in your body because your immune system can’t fight it. This is more common in people with HIV. People with active TB can pass TB on. 

Latent TB is also called inactive TB. It’s when your immune system has been able to fight the disease and stop it from causing illness. People with latent TB can’t pass TB on. In some people, TB stays inactive for their whole life. In others, TB may become active if their immune system weakens - for example by having HIV. 

Can HIV and TB be treated at the same time?

Yes. It is important to take treatment for TB and HIV so you can stay healthy. However, it can be difficult to treat both at the same time because of: 

  • the number of drugs  

  • how often they need to be taken 

  • interactions between them.  

So, tell your healthcare provider the names of all the drugs you take – including your HIV drugs, traditional or herbal medicine. They can tell you if you can take the TB drugs at the same time as your other drugs, including HIV treatment, or not.  

What is multi-drug resistant TB?

TB can become resistant to the two most powerful medicines that we have to treat it - isoniazid and rifampicin. If a TB infection is no longer able to be treated with either of these drugs, it is classed as multi-drug resistant TB. 
Multi-drug resistant TB is a big problem. Normally treatment for TB is 90% effective, but with drug resistance, this drops to as low as 50%. 
Multi-drug resistant TB is more likely to develop when a person does not adhere to treatment. Where drug-resistant TB is common in a community, it's possible to be infected with a strain of TB that's already got some resistance before you've started treatment.

Is there any extra support for people on TB treatment?

'Directly Observed Therapy' (DOT) is a way to help people take their treatment regularly. You will meet with a health worker at a clinic, in the community or at home, and they will watch and make sure that you take your medicine correctly. It's very common and can be particularly helpful for people who struggle to adhere to treatment. 
DOT works best when healthcare workers use these meetings to provide patients with additional support. This could include identifying side effects or providing counselling. The World Health Organization is currently exploring whether video calls could be used to provide DOT in a more cost- and time-efficient way. 

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