Tuberculosis & HIV - An Insight
Senior Consultant - Infectious Diseases
Fortis Memorial Research Institute, Gurgaon
March 30, 2025
In this Jivo Masterclass, Dr. Neha Rastogi Panda, Senior Consultant in Infectious Diseases at Fortis Memorial Research Institute, Gurgaon, walked through the practical diagnosis and treatment of HIV, from early testing and antiretroviral therapy through pre- and post-exposure prophylaxis and prevention of mother-to-child transmission. Using real clinic cases, including a tuberculosis and HIV co-infection, she showed how a regimen has to be built around the whole patient, not just the virus.
Questions Doctors Asked Dr. Neha Rastogi Panda
Real questions from the live masterclass, answered by Dr. Neha Rastogi Panda, Senior Consultant - Infectious Diseases.
What are the early signs of HIV?
Asked by Dr. Emanuela
The early signs, known as acute HIV syndrome, look like a flu. Most patients who are symptomatic present with intermittent fever for two to three months, fatigue or weakness, weight loss, loss of appetite, cough, cold, sore throat, more frequent minor illnesses than usual, and loose motions or diarrhoea. This symptom complex over the first month or two is what we call acute HIV syndrome.
Answered by Dr. Neha Rastogi Panda
Why don't we use the urine LAM test and stool test for all patients?
Asked by Dr. Emanuel
The urine lipoarabinomannan (LAM) test is reserved for tuberculosis diagnosis, and it has only been validated for patients with a CD4 count below 100. Below that threshold, a high tuberculosis bacterial burden allows the antigen to wash out into the urine; above it, the test loses sensitivity and specificity, so extrapolating it to every patient isn't supported. On stool testing for other opportunistic infections, a high viral load before treatment changes the normal gut flora, so a stool sample will often show excess normal flora and candida, which makes interpreting it for treatment decisions difficult specifically in HIV patients.
Answered by Dr. Neha Rastogi Panda
At what stage can we diagnose opportunistic infections, and how do we diagnose them?
Asked by Dr. Rabio
Opportunistic infections can be diagnosed at any stage; the WHO staging system, grade one through four, is built around exactly this, using the infection profile and CD4 level together. Oral thrush, for instance, usually appears at stage two, while reactive generalised lymphadenopathy sits at stage one. Sometimes the opportunistic infection is itself the first clue to an undiagnosed HIV infection, tuberculosis being the clearest example: finding it usually puts the patient at WHO stage three, and a very low viral load and CD4 count below 200 to 250 lets you further risk-stratify from there. Diagnosis runs on three legs: the clinical symptoms and signs, which organ is involved, and targeted sampling, such as testing sputum by GeneXpert for suspected pulmonary tuberculosis, or testing CSF, or serum cryptococcal antigen when CSF isn't accessible, for cryptococcal meningitis.
Answered by Dr. Neha Rastogi Panda
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