HIV and TB co-infection: treat early
Tuberculosis (TB) and HIV are 2 of the deadliest diseases worldwide, with TB recently reaching the top of the list in 2014. HIV increases the risk of contracting TB, whereas TB slows CD4 count recovery and hastens HIV progression to AIDS. Approximately 1/3 of the 1.5 million people who died of TB in 2014 were also infected with HIV.
Researchers at the Johns Hopkins University School of Medicine
published a clinical review of HIV-related TB in the February
2017 issue of Microbiology Spectrum. They compiled
current evidence and summarized recommendations for disease
diagnosis, prevention, and treatment.
Clinicians should screen all newly diagnosed HIV patients for
TB. They should screen again when the patient’s CD4 counts
fall below 200 cells/mm3 or after a new TB exposure.
Tuberculin skin tests (TSTs) are recommended over interferon
gamma release assays (IGRAs) for patients likely to require
repeated testing.
An induration ≥5 mm in an individual with HIV warrants
further testing for active TB. If extrapulmonary TB is
suspected, clinicians should obtain a sputum and smear, culture,
and order nucleic acid amplification tests.
Antiretroviral therapy (ART) and latent TB infection (LTBI)
treatment are 2 effective prophylactic measures to prevent
progression to active TB in HIV patients. These measures are
useful even in patients with high CD4 counts. Traditional LTBI
treatment involves 9 months of isoniazid therapy.
A few differences separate treatment of active TB in the
presence or absence of HIV. Patients with HIV who also have
active TB must receive daily therapy rather than alternative
intermittent dosing regimens. Clinicians must also consider drug
interactions between rifampin and certain antiretrovirals, such
as raltegravir or ritonavir.
To decrease TB-related death among patients with HIV, the
authors recommend using proper prevention and treatment
techniques in practice. To control the growth of the disease,
providers must also make an effort to extend resources to
impoverished populations with little access to care.
Reference
Tornheim JA, Dooley KE. Tuberculosis Associated with HIV Infection. Microbiol Spectr. 2017 Jan;5(1); doi: 10.1128/microbiolspec.TNMI7-0028-2016.
Source:
Pharmacy Times
