Management of TB/HIV co-infection: the state of the evidence

Torpey, Kwasi; Agyei-Nkansah, Adwoa; Ogyiri, Lily; Forson, Audrey; Lartey, Margaret; Ampofo, William; Akamah, Joseph; Puplampu, Peter

doi:10.4314/gmj.v54i3.10

Cited by 14 publications

(29 citation statements)

References 32 publications

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“… 31 In addition, the accuracy of many TB diagnostic tests is lower in PLHIV, 32 who are also more likely to have extra pulmonary TB. 33 …”

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

“… 30 , 44 In addition, smear microscopy cannot differentiate TB from non-tuberculosis mycobacteria. 33 …”

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

“…It tests for the presence of the LAM antigen, a lipopolysaccharide present in mycobacterial cells that can be detected in the urine of TB patients. 33 , 48 Compared with sputum-based testing, LF-LAM is relatively easy to perform and has minimal biosafety requirements. 33 A Cochrane review evaluating 15 studies on LF-LAM concluded that the pooled sensitivity and specificity of this test in PLHIV was 42% and 91%, respectively.…”

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

“… 33 , 48 Compared with sputum-based testing, LF-LAM is relatively easy to perform and has minimal biosafety requirements. 33 A Cochrane review evaluating 15 studies on LF-LAM concluded that the pooled sensitivity and specificity of this test in PLHIV was 42% and 91%, respectively. 49 LF-LAM had a sensitivity of 42% in PLHIV who presented with TB symptoms and 35% in those who were not assessed for TB symptoms.…”

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

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Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions

Sullivan

Nathavitharana

2022

Therapeutic Advances in Infection

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Tuberculosis (TB) is the leading cause of death in people living with HIV (PLHIV) globally, causing 208,000 deaths in PLHIV in 2019. PLHIV have an 18-fold higher risk of TB, and HIV/TB mortality is highest in inpatient facilities, compared with primary care and community settings. Here we discuss challenges and potential mitigating solutions to address TB-related mortality in adults with HIV. Key factors that affect healthcare engagement are stigma, knowledge, and socioeconomic constraints, which are compounded in people with HIV/TB co-infection. Innovative approaches to improve healthcare engagement include optimizing HIV/TB care integration and interventions to reduce stigma. While early diagnosis of both HIV and TB can reduce mortality, barriers to early diagnosis of TB in PLHIV include difficulty producing sputum specimens, lower sensitivity of TB diagnostic tests in PLHIV, and higher rates of extra pulmonary TB. There is an urgent need to develop higher sensitivity biomarker-based tests that can be used for point-of-care diagnosis. Nonetheless, the implementation and scale-up of existing tests including molecular World Health Organization (WHO)-recommended diagnostic tests and urine lipoarabinomannan (LAM) should be optimized along with expanded TB screening with tools such as C-reactive protein and digital chest radiography. Decreased survival of PLHIV with TB disease is more likely with late HIV diagnosis and delayed start of antiretroviral (ART) treatment. The WHO now recommends starting ART within 2 weeks of initiating TB treatment in the majority of PLHIV, aside from those with TB meningitis. Dedicated TB treatment trials focused on PLHIV are needed, including interventions to improve TB meningitis outcomes given its high mortality, such as the use of intensified regimens using high-dose rifampin, new and repurposed drugs such as linezolid, and immunomodulatory therapy. Ultimately holistic, high-quality, person-centered care is needed for PLHIV with TB throughout the cascade of care, which should address biomedical, socioeconomic, and psychological barriers.

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“… 31 In addition, the accuracy of many TB diagnostic tests is lower in PLHIV, 32 who are also more likely to have extra pulmonary TB. 33 …”

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

“… 30 , 44 In addition, smear microscopy cannot differentiate TB from non-tuberculosis mycobacteria. 33 …”

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

Section: Challenges That Drive Tb-related Mortality In Plhivmentioning

confidence: 99%

See 2 more Smart Citations

Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions

Sullivan

Nathavitharana

2022

Therapeutic Advances in Infection

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“…The trend of increasing CD4 counts after undergoing ARV therapy can be caused by several factors, such as adherence level, nutritional status, and drug toxicity incidence (36). ARV therapy in patients with HIV-TB coinfection does not consider CD4 cell counts; however, TB treatment remains a top priority for sufferers and must be given before patients receive ARV therapy (37). Thus, the morbidity and mortality rates in patients with HIV-TB coinfection can be reduced.…”

Section: Clinical Profile Of Patients With Hiv-tb Coinfectionmentioning

confidence: 99%

Profile of HIV/AIDS Patients Coinfected with Tuberculosis in Bumi Wonorejo Health Centre and Santo Rafael Clinic Nabire, Papua

Kridaningsih

Widiyanti

Adiningsih

et al. 2021

JKB

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<p class="Englishversionofabstract">HIV-TB co-infection still becomes a health problem in Indonesia, including in Nabire district, Papua province, which has the highest number of cases. HIV and TB infections are closely related and affect the epidemiology of one another. This study aims to determine the profile description of HIV-TB co-infected patients in Nabire. This research is a descriptive study with a cross-sectional design on 90 people with HIV/AIDS selected consecutively. Data were analyzed univariately and presented in the form of a frequency distribution table. The results showed that of 55 HIV/AIDS co-infected TB patients, almost all (90.9%) were Papuan ethnic, 70.9% were female and aged 30 to 49 years (50.9%) with a mean of 31.309.36 years. The majority of HIV-TB co-infected patients were married (63.6%), holding secondary education (58.2%), working (67.3%), engaging in sexual activity after 17 years of age, only having one sexual partner, and did not use drugs or obtain blood transfusions. The clinical profile of HIV-TB patients showed that 67.3% of the patients were with baseline CD4 count ≤350 cells/mm3, 64.8% had CD4 count at the time of study >350 cells/mm3, and viral load values fewer than 5000 copies/ml (87.3%). The therapy most widely received for patients with HIV-TB coinfection was the combination of ARV 3TC+EFV+TDF (76.4%). The most common clinical symptoms of HIV/AIDS patients were weight loss (56.4%), cough (40%), recurrent oral thrush (36.4%), chickenpox (32.7%), and tuberculosis lymph nodes (18.2%).</p>

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