The British HIV Association (BHIVA) has issued draft guidelines for the treatment of tuberculosis (TB) in patients with HIV. The draft guidelines cover TB diagnosis, treatment and prevention, and also offer recommendations for the sequencing of TB and anti-HIV therapy.
A four-drug TB regimen is recommended by the guidelines for the first two months of treatment, followed by a continuation phase involving therapy with two drugs for four months for most patients, or seven months for certain groups.
In addition to routine HIV monitoring, patients with TB should have, as a minimum, liver function tests, a sputum test and a chest x-ray, both at the commencement of treatment and at the conclusion of TB therapy.
Information on how to manage potential interactions between some anti-TB drugs and antiretroviral medicines is included, as is advice on the overlapping toxicities which some TB and HIV drugs can have, including hepatotoxicity and peripheral neuropathy.
Patients with TB whose CD4 cell count is below 100 cells/mm3 are recommended by the guidelines to start anti-HIV therapy as soon as possible. Individuals whose CD4 cell count is between 100 – 200 cells/mm3 are recommended to start HAART after two months of TB therapy, and individuals with a CD4 cell count above 200 cells/mm3 are recommended to begin HAART after completing six months of TB treatment.
Advice on treating multidrug-resistant TB, treatment during pregnancy and the management of TB reactivated by immune reconstitution is also included in the draft guidelines.
Comments are welcomed, and should be addressed to the guidelines’ author, Dr Anton Pozniak. E-mail: anton.pozniak@chelwest.nhs.uk
The draft guidelines can be viewed in pdf format on the BHIVA website.
Further information on this website
Tuberculosis - overview
Tuberculosis - factsheet
A booklet in the information for HIV-positive people series on HIV and TB will be published online very soon. Dr Pozniak offered invaluable assistance with its preparation.