Both MDR-TB and TB complicated with HIV infection are challenging to diagnose. MDR-TB refers to tuberculosis that is resistant to multiple drugs, making it harder to treat and control. TB complicated with HIV infection is also difficult to diagnose because the symptoms of both diseases can overlap, leading to delayed or missed diagnoses. Additionally, the presence of HIV weakens the immune system, making it harder to detect TB infection. Therefore, both conditions present unique challenges in terms of diagnosis, making "All of the above" the correct answer.