Tuberculosis is classically divided into states of latent infection and active disease. Using
combined positron emission and computed tomography in 35 asymptomatic, antiretroviral
therapy naïve, HIV-1 infected adults with latent tuberculosis, we identified ten individuals
with pulmonary abnormalities suggestive of subclinical, active disease who were
significantly more likely to progress to clinical disease. Our findings challenge the
conventional two-state paradigm and may aid future identification of biomarkers predictive
of progression.