Managing drug interactions in the treatment of HIV-related tuberculosis

Worldwide, tuberculosis is the most common serious opportunistic infection among people with HIV infection. The World Health Organization estimates that of the 8.7 million individuals who developed incident tuberculosis in 2011, 1. million, or 13%, were co-infected with HIV. Further, of those who suffer tuberculosis-related mortality, 31% are HIV-infected. Despite the complexities of simultaneously treating two infections requiring multidrug therapy, antiretroviral therapy is life-saving among patients with tuberculosis and advanced HIV disease.There is now clear evidence that providing antiretroviral therapy to HIV-infected adults during tuberculosis treatment, rather than waiting until completion of tuberculosis therapy, reduces mortality, particularly among those with advanced HIV disease. In one randomized controlled clinical trial among HIV-infected adults in South Africa, initiating antiretroviral therapy during tuberculosis therapy rather than waiting until tuberculosis treatment was completed reduced the hazard of all-cause mortality by 56% and was beneficial regardless of CD4 count. Subsequent clinical trials evaluating the optimal timing of initiation of antiretroviral therapy during tuberculosis treatment were conducted. Results from these trials, all of which were conducted in high prevalence/low resource settings, indicated that earlier initiation of ART significantly reduced mortality in persons with (non-meningitis) HIV-TB and CD4 cell count below 50/mm. Based on the results of these trials, the Department of Health and Human Services and Infectious Diseases Society of America now recommend that antiretroviral treatment be started two weeks after initiation of tuberculosis treatment for most patients with CD4 counts less than 50 cells/mm.Suggested citation: CDC. Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis [online]. 2013.CS242005Introduction -- Methodology for Preparation of these Guidelines -- The Role of Rifamycins in Tuberculosis Treatment -- Managing Drug Interactions with Antivirals and Rifampin -- Managing Drug Interactions with Antivirals and Rifabutin -- Treatment of Latent TB Infection with Rifampin or Rifapentine -- Treating Pregnant Women with Tuberculosis and HIV Co-infection -- Treating Children with HIV-associated Tuberculosis -- Co-treatment of Multidrug-resistant Tuberculosis and HIV -- Limitations of these Guidelines -- HIV-TB Drug Interaction Guideline Development Group \u2013 References.201