Miliary disease, disseminated tuberculosis, and tubercular meningitis are the most serious complications of primary tuberculosis. Pleural effusion and pneumothorax are the noted pulmonary complications of tuberculosis. Intestinal perfora-tion, obstruction and malabsorption are the complications of tuberculosis of small intestine. Hydronephrosis and autone-phrectomy are the renal complications, whereas paraplegia is the complication of Pott’s disease of the spine.
HIV patients with tuberculosis are more likely to progress to disseminated disease. These patients usually do not have cavi-tary pulmonary disease or upper lobe infiltrates in the lung. Patients with tuberculosis should be tested for HIV and those with HIV need to be tested periodically for tuberculosis by tuberculin skin test and chest radiography. HIV patients with a positive tuberculin skin test (TST) usually develop active tuber-culosis at a rate of 3–16% per year.
HIV reactivates latent tuberculosis infection, makes the disease more serious, and renders treatment ineffective. The patients with both HIV and tuberculosis on treatment with antiretroviral therapy develop various clinical manifestations, which include fever, lymphadenopathy, and noninvasive pul-monary infiltrates. This has been suggested due to a stronger immune response to M. tuberculosis.