Neurotuberculosis and HIV Infection

The HIV infection supported the re-emergence of TB as well as two major changes in the natural history of TB, namely it has increased the frequency of extrapulmonary TB and the mycobac‐ terial multidrug resistance. The extrapulmonary TB involvement is present in up to 40% of the HIV cases and includes respiratory, digestive, lymphatic and neurologic localizations. Of these neurotuberculosis (NTB) is probably the most devastating extrapulmonary form of TB. The risk of acquiring NTB in HIV patients has been reported as 10 times higher than in non-HIV individuals and its related mortality exceeds 50%. The prognosis is further worsened by the HIV related progressive immunodeficiency which leads to the reactivation of opportunistic infections and the development of malignancies. The early diagnosis of NTB in HIV positive patients improves the short and long term prognosis of these patients and increases their life expectancy. Unfortunately the complexity of the clinical presentation and the variability of the bacteriological results accounts for significant difficulties in the diagnostic confirmation of NTB. Therefore treatment in these patients is often empirical. Moreover the antituberculous treatment is of long duration with serious adverse effects. Ensuing complications during treatment include the immune reconstitution inflammatory syndrome (IRIS) a complication that is characteristic for HIV patients undergoing treatment for TB. Furthermore the multiple drug interactions between the antituberculous and antiretroviral treatment require close supervision of these patients.