Diagnosis & treatment of tuberculosis in HIV co-infected patients.
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Date
2011-12
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Abstract
Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public
health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to
challenges in both the diagnosis and treatment of tuberculosis. Further, there has been an increase in
rates of drug resistant tuberculosis, including multi-drug (MDR-TB) and extensively drug resistant
TB (XDRTB), which are difficult to treat and contribute to increased mortality. Because of the poor
performance of sputum smear microscopy in HIV-infected patients, newer diagnostic tests are urgently
required that are not only sensitive and specific but easy to use in remote and resource-constrained
settings. The treatment of co-infected patients requires antituberculosis and antiretroviral drugs to be
administered concomitantly; challenges include pill burden and patient compliance, drug interactions,
overlapping toxic effects, and immune reconstitution inflammatory syndrome. Also important questions
about the duration and schedule of anti-TB drug regimens and timing of antiretroviral therapy remain
unanswered. From a programmatic point of view, screening of all HIV-infected persons for TB and viceversa
requires good co-ordination and communication between the TB and AIDS control programmes.
Linkage of co-infected patients to antiretroviral treatment centres is critical if early mortality is to be
prevented. We present here an overview of existing diagnostic strategies, new tests in the pipeline and
recommendations for treatment of patients with HIV-TB dual infection.
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Keywords
Co-infection, diagnosis, drug resistance, HIV, IRIS, treatment, tuberculosis
Citation
Padmapriyadarsini C, Narendran G, Swaminathan Soumya. Diagnosis & treatment of tuberculosis in HIV co-infected patients. Indian Journal of Medical Research. 2011 Dec; 134(6): 850-865.