AEGiS-Glasgow [PL9.1] The management of tuberculosis in HIV infected patients

Seventh International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 14-17 November 2004

[PL9.1] The management of tuberculosis in HIV infected patients

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL9.1

James Hakim
College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe

In 2000 it was estimated that 9% of the 8.3 million new cases of tuberculosis in adults aged 15 to 49 years were HIV co-infected. Dual infection reaches its greatest extent in the developing world, but is important worldwide. The management of tuberculosis in HIV infected patients poses several challenges. These include issues in the management of latently infected tuberculosis patients and antiretroviral therapy. There is ample evidence that tuberculosis can be treated effectively in the presence of HIV co-infection with results that are as good as those obtained in the treatment of immunocompetent tuberculosis patients. Among the issues that must be considered when treating dually co-infected patients with antiretroviral agents are (a) timing of introduction of antiretroviral therapy (b) overlapping toxicities (c) drug-drug interactions (d) immune reconstitution reactions (e) pill burden and adherence. The timing of antiretroviral therapy must balance the benefits of immediate antiretroviral therapy against the challenges of co- treatment. The main drug-drug interaction in the management of HIV- related tuberculosis relates to the use of the rifamycins and two classes of antiretroviral drugs, namely non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Other drugs used for HIV related conditions may be important in some situations. The choice of type of rifamycins and antiretroviral agents are key factors in the drug management of HIV related tuberculosis. Anti-tuberculous and antiretroviral drugs share a range of adverse effects which can cause clinical confusion. The development of immune reconstitution reactions during the early weeks of antiretroviral therapy add to the complexity of managing dually infected patients. The magnitude of dual HIV and tuberculosis co-infection and the challenges in the management of such dually infected patients requires continual focus to ensure that new strategies and drugs are used efficiently to achieve the best outcomes.

SESSION 9: HIV-RELATED INFECTIONS, CO-INFECTIONS AND MALIGNANCIES
2004-11-14
PL9.1

Copyright © 2004 - Thomson ACUMED® All rights reserved. Thomson ACUMED® is an intelligent and innovative medical marketing and communications agency – a new division of The Gardiner-Caldwell Group Ltd, part of The Thomson Corporation, located in Tytherington, UK.

Reproduction of this abstract (other than one copy for personal reference) must be cleared through the authors.