HIV-tuberculosis coinfection: Difference between revisions

Latest revision as of 18:49, 5 January 2022

Management

Latent Tuberculosis Infection

When using isoniazid monotherapy, can use any HIV medication
When using rifampin or rifapentine, need to check for drug-drug interactions

Active Tuberculosis

Rifampin is a core antimicrobial for tuberculosis and should be given priority in drug-drug interactions
NRTIs do not require any adjustment, INSTIs and NRTIs often need dose adjustment, and PIs are usually contraindicated
Regimens that minimize drug-drug interactions:
- Efavirenz 600 mg PO daily or raltegravir 400 mg PO bid, combined with abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine
- Tenofovir disoproxil fumarate/emtricitabine + efavirenz
- Tenofovir disoproxil fumarate/emtricitabine + double raltegravir
- Abacavir/lamivudine with BID dolutegravir
- Tenofovir alafenamide may or may not be affected by rifampin
Timing
- Start TB treatment immediately
- If not already on HIV treatment:
  - CD4 count <50 cells/mm³: start HIV treatment as soon as possible, and within 2 weeks of TB treatment
  - CD4 count ≥50 cells/mm³: start HIV treatment within 8 weeks of TB treatment
  - Pregnancy, regardless of CD4: start as soon as feasible, to prevent transmission
- With tuberculous meningitis, generally defer to 8 weeks, or monitor closely when starting early

@@ Line 10: / Line 10: @@
 *[[Rifampin]] is a core antimicrobial for tuberculosis and should be given priority in drug-drug interactions
 *NRTIs do not require any adjustment, INSTIs and NRTIs often need dose adjustment, and PIs are usually contraindicated
-*Regimens that do not require dose adjustment:
+*Regimens that minimize drug-drug interactions:
 **[[Efavirenz]] 600 mg PO daily or [[raltegravir]] 400 mg PO bid, combined with [[abacavir]]/[[lamivudine]] or [[tenofovir disoproxil fumarate]]/[[emtricitabine]]
+**[[Tenofovir disoproxil fumarate]]/[[emtricitabine]] + [[efavirenz]]
+**[[Tenofovir disoproxil fumarate]]/[[emtricitabine]] + double [[raltegravir]]
+**[[Abacavir]]/[[lamivudine]] with BID [[dolutegravir]]
 **[[Tenofovir alafenamide]] may or may not be affected by [[rifampin]]
 *Timing
 **Start TB treatment immediately
 **If not already on HIV treatment:
-***CD4 count <50 cells/mm<sup>3</sup>: start as soon as possible, and within 2 weeks of TB treatment
+***CD4 count <50 cells/mm<sup>3</sup>: start HIV treatment as soon as possible, and within 2 weeks of TB treatment
-***CD4 count ≥50 cells/mm<sup>3</sup>: start within 8 weeks of TB treatment
+***CD4 count ≥50 cells/mm<sup>3</sup>: start HIV treatment within 8 weeks of TB treatment
 ***Pregnancy, regardless of CD4: start as soon as feasible, to prevent transmission
-**With tuberculous meningitis, monitor closely when starting early
+**With tuberculous meningitis, generally defer to 8 weeks, or monitor closely when starting early
 [[Category:HIV]]