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HIV and Tuberculosis: Joint Evaluation in High-Risk Patients with Immunosuppression and Chronic Cough

Medical consultation in a modern clinic: a middle-aged Hispanic physician carefully reviews medical charts on a tablet while a young patient listens from the examination table. On the wall, there is a poster of the human respiratory system and another about HIV, emphasizing the importance of joint evaluation for high-risk patients, particularly those with immunosuppression, chronic cough, and the need for ELISA testing and bacilloscopy for tuberculosis screening.

The co-infection of HIV and tuberculosis (TB) presents a significant challenge in clinical practice, especially in high-risk patients. The interaction between these two diseases not only complicates diagnosis and treatment but also increases mortality rates. The immunosuppression caused by HIV heightens susceptibility to TB, while TB can accelerate the progression of HIV. In this context, the joint evaluation of both conditions is crucial for improving clinical outcomes.

Diving Deeper into HIV-TB Co-infection

Tuberculosis is the leading opportunistic disease and cause of death in patients with HIV. In 2013, there were 1.1 million new cases of HIV/TB co-infection reported globally, accounting for 12% of incident TB cases and 360,000 deaths [1]. A common symptom in these patients is chronic cough, and its presence should alert physicians to the possibility of active TB.

Early and accurate diagnosis is essential. Bacilloscopy and the ELISA test are fundamental tools in the detection of TB and HIV, respectively. However, the implementation of routine HIV testing in patients with TB is not universal, which can lead to underdiagnosis of co-infection [2]. Additionally, drug resistance, such as resistance to rifampicin, further complicates TB treatment in patients with HIV [2].

In regions like the Asia-Pacific, although rates of HIV/TB co-infection are traditionally low, there is an observed increase in high-risk groups. This underscores the need to intensify TB case finding, preventive therapy with isoniazid, and TB infection control, as well as to improve access to antiretroviral treatment [1].

Conclusions

The co-infection of HIV and tuberculosis in high-risk patients requires comprehensive and coordinated medical attention. The implementation of joint diagnostic and treatment strategies is essential to reduce mortality and improve the quality of life for these patients. Continuous surveillance, the use of appropriate diagnostic tools, and access to effective treatments are fundamental pillars in the fight against this co-infection. Collaboration between health systems and the medical community is crucial to effectively address this public health challenge.

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Created 6/1/2025