Treatment of Tuberculosis in Special Cases

Treatment of TB/HIV co-infected patients

Consideration is needed when handling a patient with TB/HIV co-infection.

Table 7.7 Special considerations for ART in TB/HIV co-infected patients

Start ART for all TB patients living with HIV irrespective of CD4 counts	Treat TB first and start ART as soon as possible, preferably within two weeks of initiating treatment
Already on ART at TB diagnosis	Refer to HIV and AIDS chapter

Also, the following shall be considered in treatment of TB patients:

Pregnancy

Anti-TB is safe during pregnancy and breast feeding.

TB Prevention:

TPT is offered to:

Under 5 household contacts of bacteriologically confirmed PTB cases who have no active TB.
All PLHIV who have no active TB.

Dosage

In adult and adolescent

A: isoniazid (PO) 300mg 24hourly for 6months to complete one cycle of TPT

In children

A: isoniazid (PO) 10mg/kg (10-15 mg/kg) 24hourly for 6months.

Note:

TPT should only be given in one cycle in lifetime and no repeat cycle is needed.
People living with HIV who successfully completed their TB treatment should immediately receive TPT for six months.
In case of neuropathy due to INH, Pyridoxine should be used for treatment of neuropathy.
TB Preventive Therapy is not contraindicated in pregnancy and it can be given during any trimester.

Breast feeding: In the mothers with pulmonary tuberculosis, the baby should receive INH preventive (5mg/kg) for 6 months followed by BCG vaccination.

Oral contraceptives: Rifampicin interacts with oral contraceptives and reduces the efficacy of this contraception.

Liver disease: Most anti-TB medicines can cause liver damage. In case a patient develops jaundice, treatment should be stopped and restarted as soon as the jaundice resolves. In severely ill patients, start moxifloxacin and ethambutol only.

Renal failure: Ethambutol is excreted by the kidneys and should either be avoided or given in a reduced dose.