British HIV Association guidelines for the treatment of TB/HIV coinfection 2011

Table of Contents 1.0 Summary of guidelines 2.0 Introduction 3.0 Aims of TB treatment 4.0 Diagnostic tests 5.0 Type and duration of TB treatment 6.0 Drug–drug interactions 7.0 Overlapping toxicity profiles of antiretrovirals and TB therapy 8.0 Drug absorption 9.0 When to start HAART 10.0 Immune reconstitution inflammatory syndrome (IRIS) 11.0 Directly observed therapy (DOT) 12.0 Management of relapse, treatment failure and drug resistance 13.0 Pregnancy and breast-feeding 14.0 Treatment of latent TB infection – HAART, anti-tuberculosis drugs or both? 15.0 Prevention and control of transmission 16.0 Death and clinico-pathological audit 17.0 Tables 18.0 Key points 19.0 References The guidelines have been extensively revised since the last edition in 2005. Most sections have been amended and tables updated and added. Areas where there is a need for clinical trials or data have been highlighted. The major changes/amendments are: a more detailed discussion of gamma-interferon tests; new guidance on chemopreventative therapy; a complete update of the drug interactions section and tables; an updated section on choice of nonnucleoside reverse transcriptase inhibitor (NNRTI); a revised section on when to start highly active antiretroviral therapy (HAART); a new section on isoniazid resistance and extensively drug-resistant tuberculosis (XDR-TB); guidance on the diagnosis of immune reconstitution inflammatory syndrome (IRIS); new tables for management of adverse reactions. These guidelines have been drawn up to help physicians manage adults with tuberculosis (TB)/HIV coinfection. Recommendations for the treatment of TB in HIV-infected adults are similar to those in HIV-negative adults. However, there are important exceptions which are discussed in this summary. We recommend are a which physicians with in the treatment of TB and We recommend the anti-tuberculosis the of this and the treatment of HAART have an choice of We recommend on anti-tuberculosis therapy are HAART antiretrovirals to interactions with TB in which the choice of antiretrovirals is toxicity or TB treatment when drug interactions with antiretrovirals the TB of a duration of TB treatment The for TB is and drug when are on are tuberculosis treatment and We recommend of resistance in an with a of or clinical TB These tests an to HIV-infected with latent TB infection are more to to active TB and treatment of latent TB infection is diagnosis are to latent are a in active TB is in with infection with are which are more tests for active and latent in HIV-negative are more in there are data in HIV-infected have in latent TB infection and recommend the of a for latent However, and for and guidance in those with a and an and a in those with this physicians tests in there are data to this and this and in The of the an data in physicians in this We recommend for latent infection in HIV-infected on a on of and of on antiretroviral of have TB up and therapy to guidelines TB to treatment of latent which is with isoniazid for or for HAART the of of latent TB infection and is the of new We recommend HAART in with the treatment guidelines We recommend TB treatment Treatment in or highly observed therapy (DOT) to are and and where this to We recommend for treatment of in those with been with of where drug resistance is treatment with drugs and are We recommend a treatment for TB of the is drugs for isoniazid and for a of isoniazid and and of and in TB the recommend of of drugs for of isoniazid and with in in with guidelines to drug interactions TB HAART and is a of and on and with and is a of and an to of drug data to profiles of antiretrovirals and anti-tuberculosis drugs and to the with and and on isoniazid to and this with have of toxicity and need more of Drug absorption TB guidance for antiretrovirals is are clinical data to of drug are major interactions or and or of the of with TB The for have are treatment We recommend drug of and when drug are Drug of anti-tuberculosis drugs when there is clinical absorption or to TB HAART TB treatment is drug interactions and immune reconstitution and HAART to or immune have to when when to data treatment and We where of of TB when there are with drug and start HAART TB treatment guidelines for on HAART is the for TB to of the of treatment and is important to management is the of treatment We recommend in of with with or are treatment or therapy management and to clinical have in the management of and treatment HAART have a for the control and of to of transmission of TB to and guidance is in is of new TB in adults are to is in where of are of TB with of of an the an of with TB are with of adults with TB The is in with of the clinical and of TB with the with active TB are more to have or to have is The 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in this Most adults with TB are a in of and These drugs are of the of isoniazid resistance in the which is and in and those with drug tuberculosis to of isoniazid and in with to in isoniazid TB therapy with there are clinical clinical is to and the treatment is the or tuberculosis and the the this physicians to with and When are the The to with TB with and of treatment The treatment duration The to in of for or The treatment duration is therapy However, in therapy with a of resistance in However, for the for of the in HIV-negative have been with and resistance in HIV-infected and are for in this These are: in the or in with been of in TB in HIV-negative an in to drug interactions with for with similar to in a of in and a of in the However, there is a of data for in adults. is and and We recommend the drug of choice where when are to a which in the of treatment of TB in HIV-negative and is of resistance to more in and and are data the interactions of with The of TB treatment in with is 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therapy in with with and in and more there of on or and tuberculosis of the have These with more data are in recommend adults with TB of have in in TB or for a of a and in management of The of is the of The and in trials of TB are the for and the is an The guidelines on TB adults start treatment with with a to a for in the have the of and and The of to the data for an in the of in Treatment for a of for the of in of or treatment been on of duration of a of of isoniazid and and of is of the for the and those for the The Treatment are in to are of the and duration of the the on the with to for of and The the the the and is or more in treatment the the is the treatment The of for the the in treatment in the and the is or more in treatment the the is in treatment to complete a and or and and and to of with and with HIV-infected have more drug those with antiretroviral and of which We recommend tests with need for for the Most physicians the anti-tuberculosis therapy and and therapy been 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similar adverse reactions. 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