- People with HIV and latent TB infection are at much higher risk for
progressing to active TB disease than people with latent TB infection alone.
- All people newly diagnosed with HIV should be tested for TB infection.
If they are infected with TB bacteria, immediate treatment can prevent them
from progressing to TB disease.
Tuberculosis, or TB, is caused by the
bacterium Mycobacterium tuberculosis, which
can be present as either latent infection or
active disease. Latent TB infection means
that TB bacteria are living in the body but
not causing any symptoms. People with latent
TB infection are not sick, do not have
symptoms, and cannot spread the disease.
TB disease means that the bacteria are
multiplying and are destroying body tissues;
if not diagnosed and treated properly, it
can be fatal. People with TB disease are
sick, do have symptoms, and can spread the
disease. Only TB disease is infectious;
latent TB infection is not. TB disease of
the lungs or airways can be spread from
person to person through the air when a
person with TB disease coughs, sneezes,
speaks, or sings.
All people newly diagnosed with HIV
should be tested for TB infection as soon as
possible. People living with HIV and at
ongoing risk for TB exposure should be
tested annually. The risk for exposure
to TB is the same for everyone: being in
close contact with someone with infectious
TB disease. This risk increases for people
who are homeless or injection drug users, or
those living or working in settings such as
jails, health care facilities,
drug-treatment units, or homeless shelters.
TB infection can be detected by a skin
test or a blood test. If the test is
positive, additional tests such as sputum
tests and x-rays are needed to determine
whether the infection has progressed to TB
People with HIV and latent TB infection
need treatment as soon as possible to
prevent them from developing TB disease.
People with HIV who have latent TB infection
are much more likely to progress to TB
disease than people without HIV. TB
outbreaks can rapidly expand in patient
groups infected with HIV. Treatment for
latent TB infection usually is a single drug
(most commonly isoniazid) taken for 9
months. A new combination regimen of
isoniazid and rifapentine taken weekly for
12 weeks as directly observed therapy (DOT)
is recommended for some people. (In DOT,
health care workers meet with TB patients
individually to watch them take each dose of
TB medicine.) People with HIV and TB disease
must take several drugs for 6 to 9 months to
treat their TB.
Unfortunately, some people with HIV do
not know they are infected with TB.
Similarly, one in five people with TB
disease are unaware of their HIV status,
although HIV status reporting for people
with TB is improving. CDC recommends that
anyone who has TB disease, is suspected of
having TB disease, or is a contact of a TB
patient, be tested for HIV.
- In 2009, 1.1 million people in the United States were living with HIV, 18%
of whom did not know they were infected.
- The rate of new TB disease diagnoses in 2011 was 3.4 per 100,000
population (10,528 cases), the lowest since reporting began in 1953.
- In 2011, 82% of patients with TB disease knew their HIV status.
- Among 8,683 people with TB disease who had a documented HIV test result
in 2011, 6% were coinfected with HIV.
- In 2006, 12% (769 of 6,533) of TB patients with reported HIV test
results had HIV, but accounted for 32% (131 of 412) of those who died during
treatment and 51% (32 of 63) of those who received a TB diagnosis
- In 2011, the rate of incident TB cases among foreign-born people in the
United States was 12 times as great as among US-born people. Among US-born
racial and ethnic groups, non-Hispanic blacks had a rate six times that of
Multidrug-resistant TB (MDR TB) is
TB that is resistant to at least two of the
best anti-TB drugs—isoniazid and rifampin.
MDR TB is hard to treat and can be fatal.
People with HIV are at greater risk of dying
of MDR TB than those without HIV. The
percentage of MDR TB cases in the United
States has remained steady since 1998; in
2011, among all reported TB cases in the
United States, 1.3% were characterized as
primary MDR TB (defined as no previous
history of TB disease). Extensively
drug-resistant TB is a rare type of MDR TB
that is resistant not only to isoniazid and
rifampin, but also any fluoroquinolone and
at least one of three injectable second-line
drugs. It is extremely hard to treat, and
the remaining treatment options are less
To prevent the continued emergence of
drug-resistant strains, treatment for TB
must be improved, not only in the United
States but worldwide. Although a person with
drug-resistant TB can transmit the resistant
bacteria directly to others, resistance
primarily develops when a TB patient is not
treated with the right drugs or does not
take the drugs properly. The most effective
way to ensure that patients finish their
treatment is DOT, and its use must be
Possible drug interactions can
interfere with treatment. Treatment with the
right drugs is important for HIV patients.
Recommendations for treating TB in adults
with HIV are, with a few exceptions, the
same as those for adult TB patients who are
not HIV infected. However, managing
HIV-related TB is complex, and people with
HIV and TB should seek care from a health
care provider or providers with expertise in
the management of both diseases.
Lack of awareness of TB or HIV status
can prevent adequate treatment. Anyone who
is newly diagnosed with HIV or TB should be
tested for coinfection. People need to know
their status. Without treatment, each
disease increases the severity of the other.
TB disease is, in fact, an AIDS-defining
condition. Worldwide, TB is a leading cause
of death among people living with HIV.
What CDC Is Doing
CDC and its domestic and international
partners, including the National TB
Controllers Association, Stop TB USA, the
global Stop TB Partnership, the TB Trials
Consortium, and the TB Epidemiologic Studies
Consortium, are taking many steps to prevent
the further spread of TB and to reduce the
overall burden of the disease. Efforts
- Assessing new TB diagnostic
- Developing new treatment regimens.
- Increasing the capacity of health
professionals to provide adequate
patient care by offering training and
promoting evidence-based guidelines.
- Continuing to address and support
global TB control, since foreign-born
people account for more than half of TB
cases in the United States.
TB control is an exercise in vigilance.
The goal of controlling and eventually
eliminating TB requires a focused, continual
effort to meet the prevention and treatment
needs of people most at risk, including
those who have HIV. The strategy of
preventing and treating TB in people with
HIV is therefore essential to achieving the
goal of TB elimination in the United States.
1. Kaplan JE, Benson C, Holmes KH, et al; CDC;
National Institutes of Health; HIV Medicine
Association of the Infectious Diseases
Society of America.
Guidelines for prevention and treatment of
opportunistic infections in HIV-infected
adults and adolescents: recommendations from
CDC, the National Institutes of Health, and
the HIV Medicine Association of the
Infectious Diseases Society of America.
Basic TB facts.
Accessed June 11, 2012.
3. World Health Organization.
TB/HIV facts 2011/2012.
Accessed May 4, 2012.
4. CDC. Recommendations for use of an
isoniazid-rifapentine regimen with direct
observation to treat latent Mycobacterium
Mortality among patients with
tuberculosis and associations with HIV
status—United States, 1993–2008.
Reported Tuberculosis in the United
Accessed November 26, 2012.
Recommendations for human immunodeficiency
virus (HIV) screening in tuberculosis (TB)
Accessed May 4, 2012.
Monitoring selected national HIV prevention
and care objectives by using HIV
surveillance data—United States and 6 U.S.
HIV Surveillance Supplemental Report
2012;17(3):Part A. Accessed February 8,
Trends in tuberculosis—United States,
10. National Institute of Allergy and Infectious
Accessed June 11, 2012.
Plan to combat extensively drug-resistant
tuberculosis: recommendations of the Federal
Tuberculosis Task Force.
TB and HIV coinfection.
Accessed May 4, 2012.