[Diagnosis and treatment of tuberculosis or Mycobacterium avium-intracellulare complex infection in HIV-infected patients]

Abstract

The clinical features of tuberculosis vary according to its CD4 count. With CD4 count >350/microL pulmonary lesions are "typical" (upper lobe infiltrates +/- cavitation). With CD4 count< 50/microL extrapulmonary TB is more common, and chest X-rays show lower and middle lobe and miliary infiltrates, usually without cavitation. The treatment of tuberculosis in HIV-infected patients should follow the same principles for persons without HIV infection. Presence of active tuberculosis requires immediate initiation of anti-tbc therapy. The delay of antiretroviral therapy for 4-8 weeks after initiation of tuberculosis treatment is recommended. MAC is a relatively common cause of disseminated infection without pulmonary involvement in patients with AIDS. Preferred regimens contain clarithromycin and EB, and in case of high MAC load or absence of effective antiretroviral therapy rifabutin may be considered as a third drug. Start antiretroviral therapy simultaneously or within 1-2 weeks. In Japan, an increasing number of HIV infections are reported year after year. So HIV infection should be included in possible diagnosis for atypical Tbc or disseminated MAC infection.