Tuberculosis medical therapy special conditions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

HIV Coinfection

Depending on the treatment status of each patient, different approaches may be taken:

Patients Not Taking ART

• After the diagnosis of TB in HIV-positive patients, not taking antiretroviral therapy (ART), the priority is to initiate treatment for TB, along with co-trimoxazole and ART.
• These patients should be treated with the same regimen as HIV-negative patients, with the exception that the optional 3 times/week of intensive phase treatment, is mandatory for HIV-positive patients. This leads to a decrease in incidence of TB relapse and resistance to rifampicin, often seen in HIV-positive patients.
• The retreatment regimens are the same for HIV-positive and HIV-negative patients.

According to the WHO, the following recommendations should be applied to these patients:

1. Patients with TB, who are known to be HIV-positive, and all TB patients who live in areas where HIV is prevalent, should be treated with at least the intensive phase of the TB treatment.

2. During the continuation phase of the treatment, these patients should also receive a daily dose.

3. In the impossibility of taking the daily dose, a continuation phase of 3 times/week is acceptable. Regarding the duration of therapy, some experts recommend prolongation of TB treatment in certain HIV-positive patients.

4. HIV-positive patients with TB should receive TB treatment, as least for the same period of time as HIV-negative patients.

Co-trimoxazole

Preventive therapy with co-trimoxazole should be initiated as early as possible in all TB patients who are HIV-positive, and should be continued during the entire treatment of TB. Co-trimoxazol reduces the mortality rate of HIV-positive tuberculous patients, as well as infections by Pneumocystis jirovecii and malaria. After TB treatment has been complete, continuation of co-trimoxazol should be evaluated according to each country's guidelines.

Further information: HIV coinfection with tuberculosis