Tuberculosis and HIV Co-Infection (1)
exp date isn't null, but text field is
Tuberculosis and HIV Co-Infection
Active TB may be present when ART needs to be initiated or it may develop during treatment.
TB and HIV care for co-infected patients should be provided in an integrated manner under one roof by one care team (one-stop-shop).
Co-management of TB and HIV is complicated by:
- Drug interactions between rifampicin and both the NNRTI and PI classes
- Immune reconstitution inflammatory syndrome (IRIS)
- Pill burden, overlapping toxicities and adherence issues
Management
ART should be initiated in all TB/HIV co-infected people irrespective of their clinical stage or CD4 count. However, the timing of initiation of treatment may differ based on whether the patient is diagnosed with TB before or after initiating ART.
|
SITUATION |
RECOMMENDATIONS |
|
TB patients diagnosed with HIV |
Start anti-TB medicines immediately, THEN start ARVs 2 weeks later (see table below) |
|
Patient already on ART, diagnosed with TB |
Start anti-TB medicines immediately, adjust regimen as per guidelines below |
| ADULT TB patients diagnosed with TB but with CD4 <50
|
Start anti-TB medicines immediately, start ARVs before completing 2 weeks |
ARV regimen in ART-naive patients on TB treatment
|
AGE GROUP |
RECOMMENDED REGIMEN |
|
Adults, Pregnant and Breastfeeding Women, and Adolescents |
TDF+3TC+EFV |
|
Children aged 3 - < 12 years |
ABC+3TC+EFV |
|
Children 0 - < 3 years |
ABC+3TC+AZT |
ARV regimen substitution for patients initiating TB treatment while on ART
|
AGE GROUP |
REGIMEN WHEN DIAGNOSED WITH TB |
RECOMMENDED ACTION/ SUBSTITUTION |
|
Adults, Pregnant and Breastfeeding Women and Adolescents
|
If on EFV- based regimen |
Continue with the same regimen but double the dose of DTG (give DTG twice daily) |
|
If on NVP based regimen |
Substitute NVP with EFV. If EFV is contraindicated, give DTG as above. If DTG not available, give a triple NRTI regimen (ABC+3TC+AZT). |
|
|
If on LVP/r based regimen |
Continue the same regimen but double the dose of DTG (give DTG twice daily) |
|
|
If on ATV/r based regimen |
Continue the same regimen and give Rifabutin for TB treatment |
|
|
Children aged 3 - <12 years
|
If on EFV- based regimen |
Continue the same regimen |
|
If on NVP or based regimen |
Substitute NVP with EFV. If EFV is contraindicated, give a triple NRTI regimen (ABC+3TC+AZT) |
|
|
LPV/r |
Continue the same regimen and give Rifabutin for TB treatment |
|
|
Children 0 - <3 years |
If on LPV/r or NVP based regimen |
Give triple NRTI regimen ABC+3TC+AZT |
Second line ART for patients with TB
- There are significant drug interactions with PIs and rifampicin.
- If rifabutin is available, it may be used in place of rifampicin with ATV/r or LPV/r, but it is contraindicated in patients with WBC counts below 1000/mm3.
- Maintaining PI in second line regimens while switching from Rifampicin to Rifabutin (if available) is ideal
TB prevention
- BCG immunisation: it protects children against severe forms of TB. It can be given at birth. If delayed, avoid in symptomatic HIV
- IPT (Isoniazid Preventive Treatment) see Tuberculosis