Mycobacterium Tuberculosis
GENERAL PRINCIPLES
Mycobacterium tuberculosis is more frequent among HIV-infected patients. Primary or reactivated disease is common.
DIAGNOSIS
• Clinical manifestations depend on the level of immunosuppression.
Patients with higher CD4 cell counts tend to exhibit classic presentations with apical cavitary disease.• Profoundly immunosuppressed patients may demonstrate atypical presentations that can resemble disseminated primary infection, with diffuse or localized pulmonary infiltrates and hilar lymphadenopathy.
• Extrapulmonary dissemination is more common in patients with HIV.
TREATMENT
• For treatment recommendations, see Chapter 14, Treatment of Infectious Diseases.
• Current recommendations suggest the substitution of rifabutin for rifampin in patients who are receiving concomitant ART, especially PIs. The dosage for rifabutin needs readjustment due to many significant interactions. In subjects who are ART naive, ART can be delayed for a few weeks after TB- specific therapy is started.