Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

Abstract

The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.

High mortality in tuberculosis patients despite HIV interventions in Swaziland

“…[26][27][28] Increased uptake of IPT would further contribute to TB prevention in people living with HIV, and ultimately reduce TB-related mortality. 29 MDR-TB is also an increasing problem in Swaziland and, particularly if not detected or detected late, is associated with adverse outcomes.…”

Understanding the Tuberculosis Disease Progression and Future Directions of Research in Tuberculosis: A Mini Review

“…Children with HIV-positive are 20 times higher risk to develop TB and 6 times more likely to die from TB, compared to HIV-negative children (Evangelopoulos et al 2017). The development of multidrug resistance TB (MDR-TB) with co-existing HIV is even more difficult especially in low-resource countries which are usually TB-endemic, due to lack of rapid and reliable second-line susceptibility testing, more frequent extrapulmonary dissemination, higher risk of drug toxicity and incidence of immune reconstitution inflammatory syndrome (Mpagama et al 2013;Lawn et al 2013). …”

Interaction of Rifampin and Darunavir-Ritonavir or Darunavir-Cobicistat In Vitro

“…The clinical management of HIV-TB patients presents significant challenges, especially in resource-limited settings (2,4), where virological failure or intolerance to first-line antiretroviral therapy requires the use of HIV protease inhibitors (PIs) (5). PIs largely undergo phase I metabolism by cytochrome P450 3A4 (CYP3A4) and are also substrates of P-glycoprotein (P-GP; ABCB1) (6).…”

“…Rifampin (RIF) is an essential component of short-course anti-TB treatment regimens (2,10); however, RIF is also a potent inducer of the expression and activity of several metabolic enzymes, including CYP3A4 (11). The coadministration of RIF with PIs can result in clinically significant drug-drug interactions (DDIs), whereby PI bioavailability may be significantly reduced (Ͼ75%) (10,(12)(13)(14).…”