Treatment of pulmonary tuberculosis in HIV-infected adults: Follow-up after initiation of therapy
- Timothy R Sterling, MD
Timothy R Sterling, MD
- Professor of Medicine
- Vanderbilt University School of Medicine
The approach to monitoring the human immunodeficiency virus (HIV)-infected patient on antituberculous medications must include consideration of the antituberculous regimen, the antiretroviral therapy regimen, potential drug reactions, and complications related to the immune reconstitution inflammatory syndrome (IRIS).
This topic will cover the issues related to monitoring of HIV-infected patients with tuberculosis (TB), including directly observed therapy, the clinical response to treatment, adverse events related to treatment, duration of treatment, and prognosis.
Issues related to clinical manifestations, diagnosis, and treatment of susceptible TB in HIV-infected patients are discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of tuberculosis in HIV-infected patients" and "Treatment of pulmonary tuberculosis in HIV-infected adults: Initiation of therapy".)
INITIATION OF THERAPY
Issues related to selection of antituberculous therapy and antiretroviral therapy are discussed separately. (See "Treatment of pulmonary tuberculosis in HIV-infected adults: Initiation of therapy".)
DURATION OF THERAPY
The standard duration of therapy for treatment of drug-susceptible pulmonary TB in HIV-infected patients on antiretroviral therapy (ART) is six months. This includes an intensive phase of four drugs (isoniazid, a rifamycin [eg, rifampin or rifabutin], pyrazinamide, and ethambutol) administered for two months, followed by a continuation phase of two drugs (isoniazid and a rifamycin) administered for four months [1,2].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INITIATION OF THERAPY
- DURATION OF THERAPY
- CLINICAL MONITORING
- Sputum monitoring
- Drug-related side effects
- Therapeutic drug monitoring
- PATIENTS WITH INADEQUATE CLINICAL RESPONSE
- General principles
- Persistently positive sputum culture
- Persistent symptoms and/or radiographic findings
- - Intercurrent opportunistic infection
- - Immune reconstitution inflammatory syndrome
- SOCIETY GUIDELINE LINKS