Influence of HIV Infection on Pathogenesis

HIV infection is the most important risk factor for active TB. , , As CD4+lymphocytes multiply in response to the mycobacterial infection, HIV multiplies within these cells and selectively destroys them, gradually eliminating the TB-fighting lymphocytes. HIV-infected patients coinfected with TB are at a substantially higher risk of

22,23

early mortality compared with HIV-negative TB patients. ' Because of the large pill burden, overlapping toxicities, and paradoxical worsening of the TB when TB and HIV treatments are initiated simultaneously, most clinicians elect to begin TB treatment first.12,24 A reasonable time to begin HIV treatment is after 2 months of TB treatment, although individual circumstances often dictate the exact timing.

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