HIV-Associated Tuberculosis

This comprehensive review examines the epidemiology, immunopathogenesis, diagnosis, treatment, and prevention of tuberculosis (TB) in people with HIV infection. TB remains the leading cause of hospitalization and death among HIV-positive individuals globally, despite ART scale-up. The review details how HIV-induced CD4+ T-cell depletion and immune dysregulation impair granuloma formation and pathogen containment, increasing susceptibility to extrapulmonary and disseminated TB. Diagnostic challenges include atypical radiographic findings, low sputum yield, and limited sensitivity of traditional tests. Molecular assays (Xpert MTB/RIF, Ultra) and urinary LAM improve detection, especially in advanced HIV. Treatment regimens must navigate drug–drug interactions, IRIS risk, and ART timing. Rifamycin-based preventive therapies are effective but underused due to access and interaction barriers. The review also discusses emerging vaccine candidates like M72/AS01 and calls for improved diagnostics, therapies, and implementation strategies in high-burden settings.

This comprehensive review examines the epidemiology, immunopathogenesis, diagnosis, treatment, and prevention of tuberculosis (TB) in people with HIV infection. TB remains the leading cause of hospitalization and death among HIV-positive individuals globally, despite ART scale-up. The review details how HIV-induced CD4+ T-cell depletion and immune dysregulation impair granuloma formation and pathogen containment, increasing susceptibility to extrapulmonary and disseminated TB. Diagnostic challenges include atypical radiographic findings, low sputum yield, and limited sensitivity of traditional tests. Molecular assays (Xpert MTB/RIF, Ultra) and urinary LAM improve detection, especially in advanced HIV. Treatment regimens must navigate drug–drug interactions, IRIS risk, and ART timing. Rifamycin-based preventive therapies are effective but underused due to access and interaction barriers. The review also discusses emerging vaccine candidates like M72/AS01 and calls for improved diagnostics, therapies, and implementation strategies in high-burden settings.