Chart of opportunistic infections

October 2001     View PDF     En español

Tuberculosis (TB)

Tuberculosis is a bacterial infection that primarily infects the lungs.

Symptoms
Night sweats, cough, fever, shortness of breath and weight loss.

Diagnosis
Tuberculin skin test, chest X-ray, CT (chromium topography) scan or acid-fast bacilli test.

Preventive Therapy (prophylaxis)
All HIV-positive people may be at increased risk for TB and should be tested for exposure, generally with a tuberculin skin test (TST). If TST is positive (red and very inflamed) but there’s no active disease (symptoms), preventive therapy should be started. Pregnant women with no active disease may consider delaying preventive therapy until after the first trimester. If TST is positive and active disease is present, anti-TB treatment should be started.

For people sensitive to isoniazid (INH), preferred treatment: Isoniazid (300mg once a day) + pyridoxine (50mg once a day) for 9 months; isoniazid (900mg twice a week) + pyridoxine (100mg twice a week) for 9 months; or rifampin (600mg once a day) + pyrazinamide (20mg/kg once a day) for 2 months.

Alternatives: Rifabutin (300mg once a day) + pyrazinamide (20mg/kg once a day) for 2 months; or rifampin (600mg once a day) for 4 months.

For people resistant to isoniazid preferred treatment: Rifampin (600mg once a day) + pyrazinamide (20mg/kg once a day) for 2 months.

Alternatives: Rifabutin (300mg once a day) + pyrazinamide (20mg/kg once a day) for 2 months; rifampin (600mg once a day) for 4 months; or rifabutin (300mg once a day) for 4 months.

For people resistant to INH and rifampin preferred treatment: Ethambutol (15mg/kg once a day) + pyrazinamide (20mg/kg once a day) for 12 months; levofloxacin (500mg once a day) + ethambutol (15mg/kg once a day) for 12 months; or ciprofloxacin (750mg twice a day) + ethambutol (15mg/kg once a day) for 12 months.

Treatment
Preferred: Isoniazid (300mg once a day) + rifampin (600mg once a day) + pyrazinamide (20–30mg/kg once a day) + pyridoxine (50mg once a day) +/- ethambutol (15–25mg/kg once a day) all for 2 months followed by isoniazid (300mg once a day) + rifampin (600mg once a day) + pyridoxine (50mg once a day) for 4 months.

Alternative: Isoniazid (300mg once a day) + rifampin (600mg once a day) + pyridoxine (50mg once a day) +/- ethambutol (15–25mg/kg once a day).

Maintenance Therapy
Maintenance therapy is not required for people with full resolution of symptoms from anti-TB treatment.

For more information, read Project Inform’s publication, Tuberculosis.