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Tuberculosis

Tuberculosis and HIV

Tuberculosis (TB) is caused by a specific type of bacterial infection called Mycobacterium tuberculosis. TB usually affects the lungs, but it can also affect the brain, kidneys, or spine. TB is particularly dangerous to people living with HIV/AIDS. Worldwide, TB is a leading cause of HIV-related death.

TB is an issue for people living with HIV/AIDS in the U.S. because:

  • An estimated 9–14 million Americans are infected with TB bacteria. If they are not treated, between 5%–10% of them will develop TB at some point.
  • People living with HIV/AIDS are at high risk of contracting TB. As of 2005, CDC estimated 9% of all TB cases and nearly 16% of TB cases among persons aged 25–44 were occurring in HIV-infected persons.

Because of the serious health risks for coinfection with TB and HIV, the CDC recommends that all HIV-positive people should be tested for TB. Those who test positive for TB should begin treatment immediately.

For more information, see CDC’s TB and HIV/AIDS.

How TB is Spread

When a person with TB disease coughs, sneezes, speaks, or sings, TB germs are thrown into the air. These germs can float in the air for several hours. If you breathe in the air containing these TB germs, you can become infected.

TB is NOT spread by:

  • Shaking someone’s hand
  • Sharing food or drink
  • Touching bed linens or toilet seats
  • Sharing toothbrushes
  • Kissing

For more information, see CDC’s Fact Sheet: Tuberculosis: General Information.

Active v. Latent TB

There are two types of TB infection: active and latent. When people are clinically ill with TB, they are said to have “active” TB. People with active TB can spread the illness to others.

People with latent TB infection (LTBI) don’t have any signs or symptoms of the disease and don’t feel sick. They are not infectious and cannot spread TB infection to others.

But if you are living with HIV/AIDS, LTBI can be very dangerous to your long-term health, even if you don’t feel sick now. That’s because you are MUCH more likely to progress to active, severe TB disease than someone who doesn’t have HIV.

For more information, see CDC’s Tuberculosis: A Guide for Adults and Adolescents with HIV.

Symptoms

Symptoms of TB can vary from person to person. People who have LTBI will have no symptoms. People with active TB infection can experience persistent coughing (including coughing up blood), night sweats, fever, weight loss, chills, and fatigue. If you are experiencing any of these symptoms, you should consult your healthcare provider right way.

Testing

There are two types of tests to determine if you have TB infection—a skin test and a blood test.

You can get a skin test at the health department or at your doctor's office. A healthcare worker will inject a small amount of testing fluid (called tuberculin) just under the skin on the lower part of your arm. After 2–3 days, you must return to have your skin test checked by a healthcare worker. A “positive” reaction usually means that you have TB infection.

There are also new tests that use a small amount of your blood to check for TB. The advantage of the blood test is that you don’t have to wait 2–3 days for the result—but, since the tests are relatively new, not all healthcare providers offer them.

A positive TB skin test or TB blood test can only show that you have been infected with TB bacteria. It does not tell whether or not you have progressed to TB disease. You will need to take other tests, such as a chest x-ray, and give a sample of sputum, to see whether you have TB disease and whether the strain of TB is drug-resistant. These tests will help you and your healthcare provider choose the best course of treatment.

For more information, see CDC’s Tuberculosis: Questions and Answers About TB.

How Often Should I Be Tested?

In general, CDC recommends annual testing for LTBI for people living with HIV/AIDS who may be exposed to individuals with active TB. You should also be retested for TB if you are just beginning antiretroviral therapy for your HIV disease.

For additional TB testing guidelines, see CDC’s Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.

Treatment

Treatment for TB can be as challenging as treatment for HIV. There are some risks involved, mainly because the treatments can cause liver damage in some people. Treatment consists of long-term (9–12 months) antibiotic therapy for both LTBI and active disease. If you are taking antiretrovirals for your HIV disease, the treatment period may be even longer.

If you begin antibiotic therapy for TB, it’s important to take ALL your medication, on time and in the way your healthcare provider recommends. Like HIV, TB can become resistant to medications quickly if you miss doses of your meds.

For more information, see CDC’s National Prevention Information Network: TB and HIV Coinfection.

Drug–Resistant TB

Unfortunately, some strains of TB bacteria have stopped responding to medications regularly used to treat TB disease. Drug resistance is more common in people who:

  • Do not take their TB medicine regularly
  • Do not take all of their TB medicine as directed by their healthcare provider
  • Develop active TB disease again, after having taken TB medicine in the past
  • Come from areas of the world where drug-resistant TB is common
  • Have spent time with someone known to have drug-resistant TB disease

Multidrug-resistant TB (MDR TB) is TB that is resistant to at least 2 of the best anti-TB drugs—isoniazid and rifampin. MDR TB is extremely difficult to treat and can be fatal.

Although the number of cases in the United States decreased during the past few years, MDR TB has now been reported in nearly all states and the District of Columbia.

Extensively Drug-Resistant Tuberculosis (XDR TB) is resistant to the most powerful first-line and second-line drugs. Patients with XDR TB have fewer, less-effective treatment options and often have worse treatment outcomes.

People living with HIV infection or with AIDS are at greater risk of dying of MDR TB and XDR TB. For more information, see CDC’s Fact Sheet: Multidrug-Resistant Tuberculosis (MDR TB), and Fact Sheet: Extensively Drug-Resistant Tuberculosis (XDR TB).

Fact Sheets & Print Materials

Additional Resources

  • Resources Department of Veterans Affairs – Tuberculosis
  • National Institute of Allergy and Infectious Disease – Tuberculosis

Last revised: 07/30/2009