Which of the following is not a feature of TB in HIV? (AIIMS May 11 & LQ)
|A||Extrapulmonary tuberculosis is very common|
|B||Cavity formation is common|
|C||Mantoux is negative|
|D||Rifampicin is not given with protease inhibitor|
Cavity formation is common
1). All are features of TB in HIV but if we have to choose one we should go by option (B). Cavity, because during initial stage when cell mediated immunity is good there will be cavity formation BUT when CMI is compromised then cavity formation is rare…so B) OPTION seems to be most APPROPRIATE ANS….
2). TB infection is very common in HIV( 40%-50%) …
Extra Edge: HIV associated TB – –(MCQ, UPSC 2008) (Ref. Hari-18th ed., Pg- 1355)
1). TB has rapidly progressive & fatal course in HIV positive pts.
2). HIV increase reactivation of latent infection
3). Extrapulmonary tuberculosis is more common
4). Little or no cavitation , CXR may be Normal
5). Intrathoracic lymphadenopathy more common
6). Diffuse interstitial / miliary infiltrates.
7). Sputum smear positivity is less so best diagnosed by sputum Culture. Multi drug resistance is common.
8). Mtx test is negative
9). IRIS – Immune reconstitution inflammatory syndrome. (Paradoxical reactions – Exacerbations in sign symptom, lab or radiographic manifestations of tuberculosis with administration of HAART regimen)
a. Antiretroviral therapy (ART) initiation in HIV-infected patients leads to recovery of CD4+T cell numbers and restoration of protective immune responses against a wide variety of pathogens, resulting in reduction in the frequency of opportunistic infections and prolonged survival.
b. However, in a subset of patients, dysregulated immune response after initiation of ART leads to the phenomenon of immune reconstitution inflammatory syndrome (IRIS).
c. The hallmark of the syndrome is paradoxical worsening of an existing infection or disease process or appearance of a new infection/disease process soon after initiation of therapy.
d. The clinical course is characterized by marked cervical and mediastinal adenopathy accompanied by fever and weight loss during simultaneous treatment of TB and HIV disease.
e. The paradoxical reaction is attributed to partial immune reconstitution related to highly effective antiretroviral therapy.
f. Majority of patients with IRIS have a self-limiting disease course.
g. ART is usually continued and treatment for the associated condition optimized.
10). Rifampicin can induce metabolism of protease inhibitors so according to RNTCP 2010 guidelines , if patient is taking HAART then replace rifampicin with rifabutin.
11). Thiacetazone is contraindicated because it causes severe exfoliative dermatitis (FAQ).