Publication: Integrated therapy for HIV and tuberculosis
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Issued Date
2016
Resource Type
Language
eng
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic Citation
AIDS Res Ther. Vol. 13, (2016), 22
Suggested Citation
Weerawat Manosuthi, Surasak Wiboonchutikul, Somnuek Sungkanuparph Integrated therapy for HIV and tuberculosis. AIDS Res Ther. Vol. 13, (2016), 22. doi:10.1186/s12981-016-0106-y Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/2721
Research Projects
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Thesis
Title
Integrated therapy for HIV and tuberculosis
Abstract
Tuberculosis (TB) has been the most common opportunistic infection and cause of mortality among HIV-infected
patients, especially in resource-limited countries. Clinical manifestations of TB vary and depend on the degree of
immunodeficiency. Sputum microscopy and culture with drug-susceptibility testing are recommended as a standard
method for diagnosing active TB. TB-related mortality in HIV-infected patients is high especially during the first few
months of treatment. Integrated therapy of both HIV and TB is feasible and efficient to control the diseases and yield
better survival. Randomized clinical trials have shown that early initiation of antiretroviral therapy (ART) improves
survival of HIV-infected patients with TB. A delay in initiating ART is common among patients referred from TB to HIV
separate clinics and this delay may be associated with increased mortality risk. Integration of care for both HIV and TB
using a single facility and a single healthcare provider to deliver care for both diseases is a successful model. For TB
treatment, HIV-infected patients should receive at least the same regimens and duration of TB treatment as HIV-uninfected
patients. Currently, a 2-month initial intensive phase of isoniazid, rifampin, pyrazinamide, and ethambutol, followed
by 4 months of continuation phase of isoniazid and rifampin is considered as the standard treatment of drugsusceptible
TB. ART should be initiated in all HIV-infected patients with TB, irrespective of CD4 cell count. The optimal
timing to initiate ART is within the first 8 weeks of starting antituberculous treatment and within the first 2 weeks for
patients who have CD4 cell counts <50 cells/mm3. Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART
remains a first-line regimen for HIV-infected patients with TB in resource-limited settings. Although a standard dose of
both efavirenz and nevirapine can be used, efavirenz is preferred because of more favorable treatment outcomes. In
the settings where raltegravir is accessible, doubling the dose to 800 mg twice daily is recommended. Adverse reactions
to either antituberculous or antiretroviral drugs, as well as immune reconstitution inflammatory syndrome, are
common in patients receiving integrated therapy. Early recognition and appropriate management of these consequences
can reinforce the successful integrated therapy in HIV-infected patients with TB.