AEGiS-Glasgow [PL6.4] The management of TB in HIV-infected patients

Eighth International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 12-16 November 2006

[PL6.4] THE MANAGEMENT OF TB IN HIV-INFECTED PATIENTS

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. PL6.4

Stephen D Lawn
The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Purpose of the Study: The management of tuberculosis (TB) in HIV-infected patients remains a clinical challenge, especially for those working in resource-limited settings with high TB incidence. In this talk, the burden of TB among patients accessing antiretroviral treatment (ART) in both high-income and resource-limited settings will be described, and the long-term impact of treatment on risk of TB will be reviewed. Potential reasons why TB incidence remains persistently elevated during long-term ART will be explored and the implications for TB control highlighted. The potential difficulties associated with administration of ART among patients receiving rifampicin-containing TB treatment regimens are many and include pharmacokinetic interactions, impaired drug tolerability, increased pill burden, impaired adherence, co-toxicity, and management of adverse effects. However, data from several different settings now indicate that concurrent TB treatment does not undermine virological and immunological responses among patients receiving standard dose NNRTI-based regimens. The optimal time to initiate ART among patients with HIV-associated TB, however, remains unknown and there is no consensus among international guidelines. New data examining the risks associated with TB immune reconstitution disease among those receiving early ART and the mortality risk associated with delayed ART will be presented. These strongly suggest that treatment should be recommended as soon as practically possible for those with advanced immunodeficiency.

Plenary Session: HIV-related Infections, Co-infections and Malignancies I

2006-11-12
PL6.4

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