BCSE Practice Exam 2025 – Complete Study Resource

The characterization of tuberculosis (TB) reactivation in an HIV-positive individual is best understood by examining the specific clinical manifestations associated with the disease in this immunocompromised population.

When discussing TB in the context of HIV, reactivation usually occurs when dormant Mycobacterium tuberculosis is reactivated due to the weakened immune response in the individual. HIV suppresses the immune system, particularly affecting CD4 T-cell counts, which are essential for controlling TB infection.

In many cases of TB reactivation among HIV-positive patients, the classic features seen in immunocompetent individuals may not present as usually expected. Notably, individuals with HIV are less likely to experience cavitary lesions because their weakened immune response does not facilitate the typical tissue destruction associated with cavitary TB. Instead, these individuals may present with smear-negative results despite having active TB, since the bacterial load can be lower due to the compromised immune response.

Cavitation, which is a hallmark of TB in immunocompetent hosts, is often absent in those who are HIV-positive. Furthermore, due to their immunocompromised state, these patients might not exhibit the classic symptoms of TB as prominently as expected, leading to negative smear results even when cultures may still identify the pathogen.