HIV-tuberculosis coinfection: Difference between revisions
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*[[Rifampin]] is a core antimicrobial for tuberculosis and should be given priority in drug-drug interactions |
*[[Rifampin]] is a core antimicrobial for tuberculosis and should be given priority in drug-drug interactions |
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*NRTIs do not require any adjustment, INSTIs and NRTIs often need dose adjustment, and PIs are usually contraindicated |
*NRTIs do not require any adjustment, INSTIs and NRTIs often need dose adjustment, and PIs are usually contraindicated |
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| − | *Regimens that |
+ | *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]] |
**[[Efavirenz]] 600 mg PO daily or [[raltegravir]] 400 mg PO bid, combined with [[abacavir]]/[[lamivudine]] or [[tenofovir disoproxil fumarate]]/[[emtricitabine]] |
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| + | **[[Tenofovir disoproxil fumarate]]/[[emtricitabine]] + [[efavirenz]] |
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| + | **[[Tenofovir disoproxil fumarate]]/[[emtricitabine]] + double [[raltegravir]] |
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| + | **[[Abacavir]]/[[lamivudine]] with BID [[dolutegravir]] |
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**[[Tenofovir alafenamide]] may or may not be affected by [[rifampin]] |
**[[Tenofovir alafenamide]] may or may not be affected by [[rifampin]] |
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*Timing |
*Timing |
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**Start TB treatment immediately |
**Start TB treatment immediately |
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**If not already on HIV treatment: |
**If not already on HIV treatment: |
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| − | ***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 |
***Pregnancy, regardless of CD4: start as soon as feasible, to prevent transmission |
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| − | **With tuberculous meningitis, monitor closely when starting early |
+ | **With tuberculous meningitis, generally defer to 8 weeks, or monitor closely when starting early |
[[Category:HIV]] |
[[Category:HIV]] |
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Latest revision as of 14:49, 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
