Tuberculosis medical therapy special conditions: Difference between revisions
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==HIV Coinfection== | ==HIV Coinfection== | ||
{{details|HIV coinfection with tuberculosis}} | |||
Depending on the treatment status of each patient, different approaches may be taken:<ref name="pmid19105873">{{cite journal| author=Harries AD, Zachariah R, Lawn SD| title=Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 1 | pages= 6-16 | pmid=19105873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19105873 }} </ref> | Depending on the treatment status of each patient, different approaches may be taken:<ref name="pmid19105873">{{cite journal| author=Harries AD, Zachariah R, Lawn SD| title=Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 1 | pages= 6-16 | pmid=19105873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19105873 }} </ref> | ||
===Patients Not Taking ART=== | ===Patients Not Taking ART=== | ||
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* The retreatment regimens are the same for HIV-positive and HIV-negative patients. | * The retreatment regimens are the same for HIV-positive and HIV-negative patients. | ||
According to the WHO, the following recommendations should be applied to these patients:<ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref> | According to the WHO, the following recommendations should be applied to these patients:<ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref> | ||
'''''1.''''' ''Patients with TB, who are known to be HIV-positive, and all TB patients who live in areas where HIV is prevalent, should be treated with at least the intensive phase of the TB treatment.'' | '''''1.''''' ''Patients with TB, who are known to be HIV-positive, and all TB patients who live in areas where HIV is prevalent, should be treated with at least the intensive phase of the TB treatment.'' | ||
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'''''4.''''' ''HIV-positive patients with TB should receive TB treatment, as least for the same period of time as HIV-negative patients.'' | '''''4.''''' ''HIV-positive patients with TB should receive TB treatment, as least for the same period of time as HIV-negative patients.'' | ||
===Patients Taking ART=== | ===Patients Taking ART=== | ||
Besides improving the survival rate of HIV-positive patients, | |||
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Antiretroviral therapy improves survival in HIV-positive patients (16). In addition, antiretroviral therapy reduces TB rates by up to 90% at an individual level, by 60% at a population level and it reduces TB recurrence rates by 50% (21–22). ART should be initiated for all people living with HIV with active TB disease irrespective of CD4 cell count. TB treatment should be started first, followed by ART as soon as possible and within the first 8 weeks of starting TB treatment (23). | |||
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===Co-trimoxazole=== | ===Co-trimoxazole=== | ||
Preventive therapy with co-trimoxazole should be initiated as early as possible in all TB patients who are HIV-positive, and should be continued during the entire treatment of TB. Co-trimoxazol reduces the mortality rate of HIV-positive tuberculous patients, as well as infections by ''[[Pneumocystis jirovecii]]'' and [[malaria]]. After TB treatment has been complete, continuation of co-trimoxazol should be evaluated according to each country's guidelines.<ref name="pmid19105873">{{cite journal| author=Harries AD, Zachariah R, Lawn SD| title=Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 1 | pages= 6-16 | pmid=19105873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19105873 }} </ref><ref name=WHO>{{cite web | title = Co-trimoxazole prophylaxis | url = http://www.who.int/hiv/pub/guidelines/ctx/en/ }}</ref> | Preventive therapy with co-trimoxazole should be initiated as early as possible in all TB patients who are HIV-positive, and should be continued during the entire treatment of TB. Co-trimoxazol reduces the mortality rate of HIV-positive tuberculous patients, as well as infections by ''[[Pneumocystis jirovecii]]'' and [[malaria]]. After TB treatment has been complete, continuation of co-trimoxazol should be evaluated according to each country's guidelines.<ref name="pmid19105873">{{cite journal| author=Harries AD, Zachariah R, Lawn SD| title=Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 1 | pages= 6-16 | pmid=19105873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19105873 }} </ref><ref name=WHO>{{cite web | title = Co-trimoxazole prophylaxis | url = http://www.who.int/hiv/pub/guidelines/ctx/en/ }}</ref> | ||
==Extrapulmonary== | ==Extrapulmonary== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
HIV Coinfection
Depending on the treatment status of each patient, different approaches may be taken:[1]
Patients Not Taking ART
- After the diagnosis of TB in HIV-positive patients, not taking antiretroviral therapy (ART), the priority is to initiate treatment for TB, along with co-trimoxazole and ART.
- These patients should be treated with the same regimen as HIV-negative patients, with the exception that the optional 3 times/week of intensive phase treatment, is mandatory for HIV-positive patients. This leads to a decrease in incidence of TB relapse and resistance to rifampicin, often seen in HIV-positive patients.[2][3]
- The retreatment regimens are the same for HIV-positive and HIV-negative patients.
According to the WHO, the following recommendations should be applied to these patients:[3] 1. Patients with TB, who are known to be HIV-positive, and all TB patients who live in areas where HIV is prevalent, should be treated with at least the intensive phase of the TB treatment.
2. During the continuation phase of the treatment, these patients should also receive a daily dose.
3. In the impossibility of taking the daily dose, a continuation phase of 3 times/week is acceptable. Regarding the duration of therapy, some experts recommend prolongation of TB treatment in certain HIV-positive patients.[4]
4. HIV-positive patients with TB should receive TB treatment, as least for the same period of time as HIV-negative patients.
Patients Taking ART
Besides improving the survival rate of HIV-positive patients,
Co-trimoxazole
Preventive therapy with co-trimoxazole should be initiated as early as possible in all TB patients who are HIV-positive, and should be continued during the entire treatment of TB. Co-trimoxazol reduces the mortality rate of HIV-positive tuberculous patients, as well as infections by Pneumocystis jirovecii and malaria. After TB treatment has been complete, continuation of co-trimoxazol should be evaluated according to each country's guidelines.[1][5]
Extrapulmonary
Tuberculous Lymphadenitis
Skeletal Tuberculosis
Tuberculous Meningitis
Miliary Tuberculosis
Tuberculosis Peritonitis
Tuberculous Pericarditis
Renal Tuberculosis
Liver Disease
Referencies
- ↑ 1.0 1.1 Harries AD, Zachariah R, Lawn SD (2009). "Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa". Int J Tuberc Lung Dis. 13 (1): 6–16. PMID 19105873.
- ↑ Khan FA, Minion J, Pai M, Royce S, Burman W, Harries AD; et al. (2010). "Treatment of active tuberculosis in HIV-coinfected patients: a systematic review and meta-analysis". Clin Infect Dis. 50 (9): 1288–99. doi:10.1086/651686. PMID 20353364.
- ↑ 3.0 3.1 "2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition)".
- ↑ "Treatment of tuberculosis".
- ↑ "Co-trimoxazole prophylaxis".