HIV-Associated Central Nervous System Tuberculosis

Central nervous system tuberculosis (CNS TB) represents one of the most devastating manifestations of TB. HIV dramatically increases the risk of TB disease, including CNS TB. Early recognition and treatment of CNS TB, and TB meningitis in particular, is of critical importance to reducing disability and death associated with CNS TB. The diagnosis and treatment of HIV-associated CNS TB presents particular challenges for clinicians due to the increased risk of other CNS infections and malignancies, atypical cerebrospinal fluid characteristics, drug-drug interactions, timing of antiretroviral therapy and immune reconstitution inflammatory syndrome, and the increased risk of poor clinical outcomes in HIV-infected compared with HIV-uninfected CNS TB patients. The authors review recent updates and highlight challenges specific to CNS TB in the HIV-infected patient.