Question
Is it possible that I have TB without any symptoms?
30 January 2012. Related: All topics, Changing treatment, Complications and coinfections, Opportunistic infections, TB.
I had a persistent cough last year after about of PCP which is when I was diagnosed. The cough has now gone away. Since then I have been taking darunavir/ritonavir and truvada and also co-trimoxazole prophylaxis.
My HIV consultant referred me back to the respiratory physician because of my cough and did many tests since. Regular X-rays and bronchoscopy. Nothing has been cultured and I have no symptoms of TB apart from a not normal chest X-ray. He, however, seems convinced and wants to treat me which would complicate matters enormously because of the interactions involved and would probably mean changing from a regime which I tolerate well and find easy to follow.
I have heard horror stories with efavirenz and I’m not keen to use it.
Is it possible that I have TB (it’s very prevalent around here) without any symptoms and do I need treatment for it right now if it’s latent?
Answer
NOTE: please note this is a question from 2012. TB is much easier to diagnose in 2023 and HIV treatment is better and does not need to interact with TB meds. We have added links to further information and to HIV/TB guidelines at the end of this answer.
Thank you very much for your questions. I’m very sorry to hear about your infection with PCP but it’s good to know that you have recovered from the infection.
Firstly can you please tell me your current CD4 count and your viral load? If you provide me with this information alongside your treatment history, I can try to assess your situation a bit better.
Your HIV consultant is right to refer you to get your chest x-ray and bronchoscopy. By doing so they can detect if you have any other chests complications.
Can you please tell me where is your hospital/treatment centre? The main reason for me asking you is that some hospitals in the UK do have specialist team to deal with TB. If we know that you belong to one of these hospital, then we can assess your case in greater detail. This will help us to give you the proper advice that you need.
It looks like your doctor wants to give you treatment but active TB that has not been detected or confirmed. Diagnosing either active or latent TB is not always straight-forward in HIV positive people. If this is the case, and other HIV/TB experts agree, then darunavir is not recommended with rifampicin (one of the best TB meds). If you have trouble with efavirenz, or are so worried that you do not want to try this, you could ask your doctor to prescribe raltegravir (an integrase inhibitor) for the time you are on the TB treatment. You could then go back to darunavir afterwards. Even though raltegravir is more expensive, this can be prescribed when drug interactions limit other choices.
I can also understand that you are worried about changing your treatment, which was recommended by your HIV doctor. Treating TB can be very complex because careful attention should be paid to drugs interactions between TB drugs, HAART and other therapy. This is in accordance with British HIV Association (BHIVA) Guidelines. This is one of the main reason why your doctor wants to change your current HIV medication.
It is important that you get the right treatment for TB (latent). It helps to reduce the risk of reactivation of latent TB infection in the future and it is also effective at reducing the incidence of new TB. As soon as you finish your TB treatment, you do have the choice to go back to your present HIV medication again. But you need to discuss this with your HIV doctor first.
I hope to hear from you soon. Good luck and all the best.
This answer to this question from 2012 was updated in May 2023 to add the note the the answer and situtation would be different in 2023.
Thank you very much for your questions. I’m very sorry to hear about your infection with PCP but it’s good to know that you have recovered from the infection.
Firstly can you please tell me your current CD4 count and your viral load? If you provide me with this information alongside your treatment history, I can try to assess your situation a bit better.
Your HIV consultant is right to refer you to get your chest x-ray and bronchoscopy. By doing so they can detect if you have any other chests complications.
Can you please tell me where is your hospital/treatment centre? The main reason for me asking you is that some hospitals in the UK do have specialist team to deal with TB. If we know that you belong to one of these hospital, then we can assess your case in greater detail. This will help us to give you the proper advice that you need.
It looks like your doctor wants to give you treatment but active TB that has not been detected or confirmed. Diagnosing either active or latent TB is not always straight-forward in HIV positive people. If this is the case, and other HIV/TB experts agree, then darunavir is not recommended with rifampicin (one of the best TB meds). If you have trouble with efavirenz, or are so worried that you do not want to try this, you could ask your doctor to prescribe raltegravir (an integrase inhibitor) for the time you are on the TB treatment. You could then go back to darunavir afterwards. Even though raltegravir is more expensive, this can be prescribed when drug interactions limit other choices.
I can also understand that you are worried about changing your treatment, which was recommended by your HIV doctor. Treating TB can be very complex because careful attention should be paid to drugs interactions between TB drugs, HAART and other therapy. This is in accordance with British HIV Association (BHIVA) Guidelines. This is one of the main reason why your doctor wants to change your current HIV medication.
It is important that you get the right treatment for TB (latent). It helps to reduce the risk of reactivation of latent TB infection in the future and it is also effective at reducing the incidence of new TB. As soon as you finish your TB treatment, you do have the choice to go back to your present HIV medication again. But you need to discuss this with your HIV doctor first.
I hope to hear from you soon. Good luck and all the best.
Further info
TB and HIV coinfection (from the i-Base training manual)
https://i-base.info/ttfa/5-ois-and-coinfections/7-tuberculosis-tb
UK (BHIVA) guidelines on HIV and TB coinfection.
https://www.bhiva.org/TB-guidelines
This answer to this question from 2012 was updated in May 2023 to add the note the the answer and situtation would be different in 2023.
Nice post thanks for sharing
Hi there,
Have your doctors considered the possibility that you have a histoplasmosis infection? I am in the process of being diagnosed, and long story short, I am a biologist who climbed into a bat-infested tree known (not by me at the time) to harbor this particular fungus. In a chest X-ray, it presents as miliary TB, but after an initial stage of obvious illness there are otherwise no symptoms. Early on I experienced a high fever for several days, followed by persistent cough (mostly dry cough) and fatigue. Now, six weeks later, I have completed field work and have finally been able to see a doctor. I have no symptoms, other than a completely abnormal chest X-ray. The doctors are in the process of ruling out TB, but are 99% sure that it is histoplasmosis.
Histoplasmosis can be acquired in less dramatic ways (living near bird colonies or filthy areas), and is more likely to affect immunosuppressed individuals, particularly individuals with HIV. Of course, relying on blood tests and cultures to rule out TB and confirm histoplasmosis is essential. I am in fact still waiting for my results.
Best of luck!