Subclinical Tuberculosis in HIV-Infected Patients: Another Challenge for the Diagnosis of Tuberculosis in High-Burden Countries?

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Abstract
For the more than 2 decades that tuberculosis has been recognized as a major opportunistic infection in patients with HIV infection/AIDS, the extraordinary spectrum of clinical presentations has made the diagnosis of tuberculosis very challenging. This spectrum includes both pulmonary and extrapulmonary disease, which often has atypical clinical and radiographic manifestations in HIV-infected patients, compared with those in HIV-negative patients [1]. The problem is compounded even more in developing countries where rates of Mycobacterium tuberculosis and HIV coinfection are high [2] and the resources and facilities for both radiographic and microbiologic diagnoses are often limited or nonexistent. For example, in many parts of the world, sputum smears for detection of acid-fast bacilli (AFB)—but not cultures—are used for the diagnosis of pulmonary tuberculosis.