Unmasking tuberculosis in the era of antiretroviral treatment

Eur Respir J. 2012 May;39(5):1064-75. doi: 10.1183/09031936.00116611. Epub 2011 Oct 17.


Tuberculosis (TB) can develop soon after antiretroviral treatment initiation, as the result of restoration of the anti-TB specific immune response. This form of the disease is often defined as "unmasked TB", and it represents a major challenge for severely immune-suppressed HIV-infected subjects initiating treatment. Emergence of previously unrecognised TB disease occurs frequently in countries where TB/HIV co-infection is common, and where antiretroviral treatment has become increasingly accessible. The challenges posed by unmasked TB, such as its high incidence, the lack of reliable diagnostic tools and the uncertainties on its optimal management, may hamper our ability to face the TB/HIV epidemic. Therefore, unmasked TB appears a major threat to global health and poses additional barriers to successful HIV/AIDS care and treatment programmes. This review focuses on the epidemiology, immunopathogenesis and clinical manifestations of unmasked TB, and provides evidence-based recommendations for management and care of the disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / chemically induced
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / epidemiology
  • Anti-Retroviral Agents / adverse effects*
  • Anti-Retroviral Agents / therapeutic use*
  • Antitubercular Agents / therapeutic use
  • Developed Countries / statistics & numerical data
  • Developing Countries / statistics & numerical data
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Humans
  • Incidence
  • Male
  • Prevalence
  • Risk Factors
  • Tuberculosis, Pulmonary / chemically induced*
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology
  • Tuberculosis, Pulmonary / prevention & control


  • Anti-Retroviral Agents
  • Antitubercular Agents