LIVING WITH HIV

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Around the world, more than 10 million people become ill with tuberculosis (TB) every year, and it remains the leading cause of death among people living with HIV.[1] As HIV weakens the immune system, people living with HIV are sixteen times more likely to become ill with TB compared to people living without HIV.[2]

What Is TB?

Tuberculosis, TB, is a disease that is caused by a bacterium called Mycobacterium tuberculosis.[3,4] TB usually affects the lungs, although it can affect other parts of the body such as the kidneys and spine. It’s preventable and curable, however, if not treated, it can be fatal.[3]

TB is spread through the air from person to person.[2] When a person with the TB bacteria coughs, speaks or sneezes, TB bacteria droplets are released into the air and can be inhaled by people nearby.[3,4]

If you have TB, it could be inactive or active.[3] Regardless of which type you have, it’s important to reach out to a healthcare professional for treatment.

Inactive TB

Inactive TB, sometimes called latent TB, is where the bacteria are living in the body but they haven’t grown or spread.[3] This means that the bacteria don’t make you sick and you can’t spread them to others.

However, inactive TB can advance and change into active TB. An inactive TB infection is more likely to advance to an active state in people with living HIV, compared to people living without HIV.[3]

Active TB

If you have active TB, the bacteria are not only present in the body but they grow and spread. This makes you contagious and you can spread the bacteria to others.[3]

WHAT IS THE RELATIONSHIP BETWEEN HIV AND TB?

TB is an opportunistic infection (OI). This is a type of infection that occurs more often, or more severely, in people with weakened immune systems. As HIV weakens your immune system, the risk of TB in people living with HIV is increased. If you have both HIV and TB, this is called a coinfection.[3] 

Below, watch Dr Annemiek de Ruiter and Dr Simon Tiberi discuss what TB is and why it affects people with HIV.

TB and HIV coinfection rates can vary greatly globally, ranging anywhere from around 3% to as high as 65-72%. Lower middle-income countries have the highest numbers of people living with HIV and TB, particularly sub-Saharan Africa.[5]

In the Western world, HIV and TB coinfection rates are typically low. For example, in 2022, there were 4,380 UK cases of TB recorded, and only 3.6% of these cases had an HIV coinfection. Incidences of TB are often impacted by social risk factors such as alcohol misuse, homelessness, and imprisonment.[6]

Regardless of where you live, it’s important to be mindful of the intersection between HIV and TB. In people living with HIV, TB is considered to be an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people living with HIV.[3,5]

Although deaths from TB in people living with HIV have been reducing over the years, in 2022, about 167,000 people still died of HIV-associated TB, representing 27% of all HIV-related deaths.[2,7]

WHAT ARE THE SYMPTOMS OF TB?

Common symptoms of active TB include:[2]

  • A prolonged cough (sometimes with blood)
  • Chest pain
  • Weakness and fatigue
  • Fever and night sweats
  • Weight loss

Symptoms of TB can vary depending on which part of the body is affected, and they can be mild for a long time. This means you could have TB without even realising it.[2]

Understand how symptoms of TB can overlap with other conditions

In the video below, Vincent discusses his experience of living with HIV and a TB coinfection. Experts also discuss how the symptoms of TB overlap with other conditions and how there can be trouble with diagnosis.

GettIng tested for TB

Depending on your location, if you are living with HIV you should be able to get regular TB tests.[8,9] In some countries, these are provided as part of your routine care.[8]

If you are living with HIV and you develop any TB symptoms, seek medical help immediately and get tested.[2,9] You should also make sure you get a TB test if you’ve come into contact with someone who has TB.[2]

It is important to note that a TB test cannot detect HIV, but if you test positive for TB and are at risk for HIV, you should also get an HIV test for a complete diagnosis.[10] New rapid tests that can detect early stages of both HIV and tuberculosis are being explored to improve outcomes for those living with HIV and TB coinfection.[10]

There are several ways to test for TB.[11,12] These include a blood test, a skin test, a tissue or mucus sample, and X-rays.[11,12]

How Is TB treated?

If you have an HIV and TB coinfection, it’s important that you get treated for both diseases. There are preventative medicines that can stop inactive TB from becoming active TB. These include antibiotics, which need to be taken for several months.[2,3,13]

However, if you have active TB, you'll likely be treated with a mix of antibiotics for six to twelve months.[14] The standard treatment typically includes Isoniazid along with rifampin, pyrazinamide, and ethambutol.[14]

It’s also important to continue taking your HIV medication, such as antiretroviral therapy (ART). Some TB treatments may interact with HIV medications, so it’s important to make sure you are on the right dose of medication and carefully monitored by your healthcare team if taking both medications together.[3]

References:

  1. World Health Organization. Global tuberculosis report. 2023. 75 p. Available from: https://iris.who.int/bitstream/handle/10665/363752/9789240061729-eng.pdf?sequence=1. [Accessed September 2024]
  2. World Health Organization. Tuberculosis . Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis [Accessed September 2024]
  3. NIH. HIV and Tuberculosis (TB). Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-tuberculosis-tb. [Accessed September 2024]
  4. World Health Organization. Global Tuberculosis report. 2022. 68 p. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022. [Accessed September 2024]
  5. Belay M, Bjune G, Abebe F. Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, northeast Ethiopia. Glob Health Action. 2015 Dec 18;8(1):27949.
  6. GOV.UK. TB incidence and epidemiology, England, 2022. 2022. Available from: https://www.gov.uk/government/publications/tuberculosis-in-england-2023-report-data-up-to-end-of-2022/tb-incidence-and-epidemiology-england-2022. [Accessed October 2024]
  7. World Health Organization. Reduce the burden of TB among people living with HIV. In: WHO consolidated guidelines on tuberculosis: Module 6: Tuberculosis and comorbidities/2024. Available from: https://iris.who.int/bitstream/handle/10665/376584/9789240087002-eng.pdf?sequence=1. [Accessed October 2024]
  8. Public Health England. Universal HIV testing for tuberculosis (TB) patients. 2019. Available from: https://assets.publishing.service.gov.uk/media/5df8abc7ed915d093cec0933/RA_HIV_testing.pdf. [Accessed October 2024]
  9. MN Department of Health. HIV and TB: A Fact Sheet for HIV Care Providers in Minnesota. 2022. Available from: https://www.health.state.mn.us/diseases/hiv/hcp/hivandtb.html. [Accessed September 2024]
  10. Li L, Lyon CJ, LaCourse SM, Zheng W, Stern J, Escudero JN, et al. Sensitive blood-based detection of HIV-1 and Mycobacterium tuberculosis peptides for disease diagnosis by immuno-affinity liquid chromatography-tandem mass spectrometry: A method development and proof-of-concept study. Clin Chem. 2023 Dec 1;69(12):1409–19.
  11. CDC. Testing for Tuberculosis. Tuberculosis (TB). 2024. Available from: https://www.cdc.gov/tb/testing/index.html. [Accessed September 2024]
  12. NHS. Tuberculosis (TB). Available from: https://www.nhs.uk/conditions/tuberculosis-tb/. [Accessed September 2024]
  13. CDC. TB Treatment for Persons with HIV. 2024. Available from: https://www.cdc.gov/tb/topic/treatment/tbhiv.htm. [Accessed September 2024]
  14. American Lung Association. Treating and Managing Tuberculosis. 2024. Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/tuberculosis/treating-and-managing. [Accessed September 2024]

NP-GBL-HVX-COCO-250004 February 2025

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the GSK Reporting Tool link https://gsk.public.reportum.com/. By reporting side effects, you can help provide more information on the safety of this medicine.

If you are from outside the UK, you can report adverse events to GSK/ ViiV by selecting your region and market, here.