Diagnosis and treatment of extrapulmonary tuberculosis in HIV-infected patients: a persistent challenge

This review summarizes the current knowledge regarding the epidemiology, diagnostic challenges, and therapeutic considerations of extrapulmonary tuberculosis (EPTB) in HIV-infected patients. Individuals with advanced HIV infection are particularly vulnerable to EPTB and disseminated disease; extrapulmonary involvement is observed more frequently than in non-HIV-infected populations. Diagnostic evaluation is complicated by the reduced sensitivity of smear microscopy and histopathology due to impaired granuloma formation. Therefore, molecular assays, blood cultures, and urine lipoarabinomannan testing may serve as useful adjuncts. Therapeutic management requires careful attention to drug–drug interactions between rifamycins and antiretroviral agents, as well as the risk of immune reconstitution inflammatory syndrome and timing of initiating antiretroviral therapy. Although many uncertainties remain, maintaining a high index of suspicion and adopting a multifaceted diagnostic and therapeutic approach may improve outcomes in patients with HIV-associated EPTB.