4. Diagnosis

National Tuberculosis Programmes in resource-limited settings have adapted different diagnostic algorithms for the diagnosis of TB in HIV co-infected patients. Most of the diagnostic approaches are based on clinical screening algorithms, sputum smear microscopy and chest radiography. Although the use of TB culture and molecular techniques, such as Xpert MTB/RIF (GeneXpert) is increasing, access remains limited in most low-resource settings.

WHO (2013) recommends that every person with HIV should be screened for TB, followed by either further diagnostic procedures or isoniazid prophylaxis (Isoniazid preventive therapy, IPT) (see Figure 3)



TB diagnosis in HIV patients is challenging.

Variable clinical presentation, atypical or normal radiographic findings, increased prevalence of smear negative PTB and EPTB all contribute to delay in diagnosis and increased mortality in patients with TB-HIV co-infection. An expert group at WHO has therefore developed guidelines to improve diagnosis and treatment of smear-negative and extra-pulmonary tuberculosis.

For further reading, we would recommend to read:

  WHO recommendations Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents”, 2007.

iDevice icon Reflection
The WHO guidelines aim at a faster diagnosis and treatment of TB in HIV patients with suspected TB. What are the essential points of the 2010 TB guidelines?