Adult antiretroviral therapy guidelines 2017

Meintjes, Graeme; Moorhouse, Michelle; Carmona, Sergio; Davies, Nick; Dlamini, Sipho; Vuuren, C.V. van; Manzini, Thandekile C.; Mathe, Moeketsi; Moosa, Yunus; Nash, Jennifer; Nel, Jeremy; Pakade, Yoliswa; Woods, Joana; Zyl, Gert van; Conradie, Francesca; Venter, François

doi:10.4102/sajhivmed.v18i1.776

Cited by 172 publications

(185 citation statements)

References 68 publications

(70 reference statements)

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“…HIV‐positive people who are not yet on antiretroviral therapy (ART) at the time of TB diagnosis and who have a CD4 count <50 cells/μL should have their ART initiated within 2 weeks of TB therapy; in all other cases, a delay of 6–8 weeks before ART initiation is acceptable …”

Section: Managementmentioning

confidence: 99%

Tuberculous pleural effusion

2019

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Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

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Section: Managementmentioning

confidence: 99%

Tuberculous pleural effusion

2019

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“…The current preferred first-line regimen is a fixed-dose combination tablet comprising three antiretroviral agents, including efavirenz (EFV). [1] Isoniazid (INH) is being increasingly used as tuberculosis (TB) prophylaxis, especially in HIV-positive individuals. This means that a high proportion of patients in SA are likely to be receiving concomitant EFV and INH therapy.…”

Section: In Practicementioning

confidence: 99%

A proposed management algorithm for late-onset efavirenz neurotoxicity

et al. 2018

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“…Patients who are on both ART and anti‐TB therapy may experience immune reconstitution inflammatory syndrome (IRIS) as well as significant drug‐drug interactions, especially if on protease inhibitor‐based regimens. Such patients require the attention of experienced centers . The time to resolution of fever with appropriate therapy can range from 2 weeks to 2 months, though therapeutic thoracentesis may reduce the interval and may be repeated at least once .…”

Section: Managementmentioning

confidence: 99%

“…Such patients require the attention of experienced centers. 63 The time to resolution of fever with appropriate therapy can range from 2 weeks to 2 months, though therapeutic thoracentesis may reduce the interval and may be repeated at least once. 14 The time to radiographic resolution ranges from 6 to 12 weeks or longer, dependent on the size of the effusion and the burden of disease.…”

Section: Detection Of Mycobacteriamentioning

confidence: 99%

Pleural tuberculosis: A concise clinical review

Shaw

Irusen

Diacon

et al. 2018

Clinical Respiratory J

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Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. TB pleurisy can also present as loculated neutrophil-predominant effusions which mimic parapneumonic effusions. Rarely, they can present as frank TB empyema, containing an abundance of mycobacteria. Up to 80% of patients have parenchymal involvement on chest imaging. The diagnosis is simple if M. tuberculosis is detected in sputum, pleural fluid or biopsy specimens, and the recent advent of liquid medium culture techniques has increased the microbiological yield dramatically. Where the prevalence of TB is high the presence of a lymphocyte-predominant exudate with a high ADA has a positive predictive value of 98%. In low prevalence areas, the absence of an elevated ADA and lymphocyte predominance makes TB very unlikely, and pleural biopsy should be performed to confirm the diagnosis. Pleural biopsy for liquid culture and susceptibility testing must also be considered where the prevalence of drug resistant TB is high. Treatment regimens are identical to those administered for pulmonary TB. Initial pleural drainage may have a role in symptom relief and in hastening the resolution of the effusion. Surgical intervention may be required in loculated effusions and empyemas.

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Adult antiretroviral therapy guidelines 2017

Cited by 172 publications

References 68 publications

Tuberculous pleural effusion

Tuberculous pleural effusion

A proposed management algorithm for late-onset efavirenz neurotoxicity

Pleural tuberculosis: A concise clinical review

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