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HIV 8 – Tuberculosis (TB)

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What is TB?

Tuberculosis, abbreviated TB, is an infection that usually affects the lungs and can be serious, particularly for people living with HIV who have a low CD4 count. The good news is that TB can be cured if treated early on.2a

750 out of every 100 000 South Africans are estimated to be infected by tuberculosis (TB)

People living with HIV are currently at the highest risk of both contracting and dying of TB.1a 

To find out more information about how HIV and TB are linked, read below.

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Drug resistance

Unfortunately, there is some measure of drug resistance to some TB drugs. This means that in some people, the usual drugs do not work. This is called drug resistant TB, and a person may have to take different combinations of medicines to target the resistant bacteria.4f

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Did you know?

The earliest historical references to TB in Egypt are in a medical papyrus dated to 1550 BC.3a

Although TB was present in Europe in the middle Ages, it was in the 1600s that the disease reached epidemic proportions.3b By the mid seventeenth century, one in every five deaths in the city of London, was due to TB. From then until the 1800s, it was called the White Plague of Europe.3b

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How is a person infected with TB?

TB is spread when someone infected with TB coughs or sneezes and expels the bacteria in little droplets.2b 

TB does not cause illness in everyone, it depends on how strong the immune system is:

A person can be infected with TB and not have any symptoms, this is called latent TB. During this time they cannot pass it on to other people. On the other hand, active TB is what happens when a person with latent TB then becomes sick and this can be spread from one person to another.4a,b

How many people with latent TB will progress to active TB? An estimated 10% of people with latent TB, who do not receive treatment, will become sick at some stage in their lives.4b

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What is the connection between TB and HIV?

Because HIV weakens the immune system, when that person becomes infected with TB, their body cannot fight off the bacteria and they become sick soon after they have become infected therefore resulting in the presentation of Active TB.4c

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Facts about TB:

  • Without treatment, TB is potentially life-threatening.2d
  • TB is the leading cause of death among people living with HIV.2e,5a
  • Active TB accelerates HIV disease progression.6a
  • Antiretroviral therapy (treatment for HIV) restores the immune system thereby reducing the risk of developing TB.5a
  • TB is preventable and curable if treated early on.4e,g
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Getting tested

Free testing for TB can be done at your nearest clinic. Testing for children is done using skin tests and chest X-rays. Testing for adults is done by taking two sputum (saliva) samples and the results are normally available after 2 – 3 days.7a

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Getting treated

It is important to note that treatment will only be successful if the drugs are taken EXACTLY as required for the entire duration, which is usually a 6 month period.4e

The risk for other opportunistic infections is higher in HIV/TB-co-infected persons than in HIV positive persons without TB.6b

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Types of medicines:

Anti-TB drugs improves survival and quality of life for people with TB and also reduces the chance of spread of infection.6c A combination of drugs are used to treat TB infection.4e

Rifampicin and Isoniazid are both anti-TB drugs used to treat TB infection.1b,2f

Vitamin B6, also called pyridoxine, is used to prevent isoniazid-associated side-effects.1b

Cotrimoxazole is a combination of two antimicrobial drugs used to prevent additional infections that might occur if a patient has HIV and TB.1b

Fortunately, companies are continually researching ways to improve TB therapy and one way that can be done is to improve the way in which tablets are taken. There is now a convenient 3-in-1 tablet that incorporates 3 of the above medicines in one tablet taken once-a-day.1c

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Drug interactions

There are important drug interactions that can occur when both HIV and TB treatment are given together.8a For more information on drug interactions, read further here.

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The importance of PREVENTION

TB can be prevented by stopping the spread of bacteria from one person to another.4g

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How can this be done?



The overriding message for people living with HIV and at high risk of developing TB, is that they must ensure their HIV treatment is taken correctly and consistently. This is essential for restoring the immune system and thereby reducing the risk of developing TB and other infections.8b

Medical References

  1. Cipla’s novel solution to prevent TB in people living with HIV/AIDS [Online; Date]. Available from: Last accessed August 2020.
  2. Corkery S. Tuberculosis & HIV. Tuberculosis [December 2017]. AIDSMAP. Available from: Last accessed August 2020.
  3. ORG. History of Tuberculosis (TB) – World history, start of TB, then through the centuries [August 2020]. Available from: Last accessed August 2020.
  4. ORG. TB – disease, symptoms & treatment [July 2020]. Available from: Last accessed August 2020.
  5. Alcorn K. Tuberculosis & HIV. TB clusters how where HIV treatment is missing in South Africa [August 27, 2019]. AIDSMAP. Available from: Last accessed August 2020.
  6. National Consolidated Guidelines for the management of HIV in adults, adolescents, children and infants and prevention of mother-to-child transmission. South African National Department of Health, February 2020.
  7. South African Government. What is TB and where can I get treatment? Available at Last accessed August 2020.
  8. Meintjes G, Moorhouse MA, Carmona S, et al. Adult antiretroviral therapy guidelines 2017. S Afr J HIV Med 2017;18(1):a776.
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