Virtual Patient Reference Library
Clinical Aspects of HIV Infection
page 19
Primary HIV Syndrome
Epidemiologic Overview and Classification
  Table 1: Indicator Conditions for Case Definitions of AIDS
HIV Testing
  Introduction
  Pretest Counseling
  Methods
  Post-test Counseling
  Risk Reduction
Initial Evaluation
  History
  ROS & PE
  Laboratory
  CD4 & Viral Load
Spectrum of HIV Disease
Stratified Management
Follow-up
Routine Health Care Maintenance
  Immunizations
  Table 1: Immunizations
  Gynecologic Care
  Tuberculosis Prevention

   last update February 2003
 Routine Health Care Maintenance - Tuberculosis Prevention
Tuberculosis (TB) testing is indicated as part of initial evaluation of HIV-infected patients and should be repeated annually in those who are seronegative.

Testing is performed with PPD (purified protein derivative [intermediate strength, 5TU]) administered intracutaneously and read at 48-72 hours. Routine use of control agents, such as candida, tetanus toxoid, and mumps, is no longer recommended because of their lack of standardization. A positive test in an HIV-infected patient is defined as 5 mm or more of induration.

Prophylactic antimicrobial therapy is recommended for HIV-infected patients regardless of age with any of the following:
  1. Positive PPD
  2. History of a positive PPD and no documentation of a standard course of prophylaxis
  3. Recent exposure to pulmonary TB
Chest x-ray should be performed on all patients with a positive PPD to rule out active pulmonary TB before initiating antimicrobial prophylaxis. If extrapulmonary disease is suspected clinically, the appropriate additional diagnostic evaluation should also be completed.

Isoniazid (INH) 300 mg po qd given with pyridoxine 50 mg po qd in those with a history of alcoholism or nutritional deficiency is the standard prophylactic regimen; treatment is provided for nine months.