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Treating Tuberculosis in People With HIV

Topic Overview

Treatment for people with tuberculosis (TB) who also have human immunodeficiency virus (HIV) is nearly the same as for people who don't have HIV. But there are some important differences, including: 1

  • Checking to make sure that the TB medicines are not changing the effectiveness of the medicines used to treat the HIV infection.
  • Continuing treatment for longer than 6 months. Treatment may go on for up to 9 months for people with both TB and HIV infections, especially for children.
  • Avoiding the once-a-week treatment program when using isoniazid-rifapentine after the first 2 months of TB therapy. Instead, the medicines should be taken every day or 3 times a week.
  • Avoiding the twice-a-week treatment program when using isoniazid-rifampin or rifabutin for people whose CD4+ lymphocyte counts are less than 100/µl (100 cells per microliter). Instead, the medicines should be taken every day or 3 times a week.

Treatment of latent TB in people with HIV infection

Experts recommend one of the following treatments to cure a latent TB infection in people with HIV infection.

  • Nine months of daily treatment with the antibiotic isoniazid can help latent TB from becoming active TB, which can spread to other people. 1
  • Three months of weekly doses of the antibiotics isoniazid and rifapentine can be effective for treating latent TB in people with HIV who are not taking antiretroviral medicines. 2 For this treatment, a health professional watches you take each dose of antibiotics, called directly observed therapy (DOT) . Making sure that every dose of antibiotic is taken helps prevent the TB bacteria from getting resistant to the antibiotics.

Treatment of active TB in people with HIV infection

People who are infected with HIV take a combination of four medicines daily for 2 months to treat active TB. This is followed by two medicines daily for the next 4 months. 1

  • Appropriate treatment should last for at least 6 months. Treatment may go on longer if tests show that TB-causing bacteria are still present in sputum or in other areas of the body.
  • All doses of the antibiotics must be taken. This may require daily visits with a health professional to receive every dose of your medicines. This is called directly observed therapy (DOT) , and it improves the cure rate of TB treatment. 3
  • Doctors may use another medicine instead of rifampin, which can lower the effectiveness of some medicines used to treat HIV infection.

References

Citations

  1. American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America (2003). Treatment of tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167(4): 603–662.
  2. Centers for Disease Control and Prevention (2011). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR, 60(48): 1650–1653. Available online:
  3. Tuberculosis Coalition for Technical Assistance (2006). International standards for tuberculosis care (ISTC). Available online: http://www.who.int/tb/publications/2006/istc_report.pdf.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care Medicine, Medical Toxicology
Last Revised April 4, 2013

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