Concurrent Drug Therapy for Tuberculosis and HIV Infection in Resource-Limited Settings: Present Status and Future Prospects

Rapid scale-up of antiretroviral treatment (ART) in resource-limited settings where the burden of tuberculosis (TB) is high has resulted in the increasingly frequent need for patients to receive TB treatment and ART concurrently. This presents a major challenge to ART programs in these settings, where the therapeutic options and the healthcare infrastructure to effectively deliver and monitor overlapping treatment are limited. This article reviews the issues of pharmacokinetic interactions, drug cotoxicity and TB immune reconstitution disease. The currently available treatment options and the impact of concurrent treatment on patient outcomes are described. The use of ART in the treatment of HIV-associated multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) is also considered. Finally we discuss how new therapeutic agents currently in development may improve treatment options in the future.