12.2 Concomitant treatment of tuberculosis and HIV co-infection

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    12.2.1 Active tuberculosis

    For all HIV-infected patients, treatment of active TB should be started first.

    Antiretroviral therapy (ART) should be initiated within 2 weeks of starting treatment of active TB, except for patients with TB meningitis.

    For patients with TB meningitis, early initiation of ART is associated with an increased risk of serious adverse events. It is therefore recommended to start ART 4 to 8 weeks after the start of TB treatment [1] Citation 1. World Health Organization. Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring: March 2021. Geneva: World Health Organization; 2021.
    https://apps.who.int/iris/rest/bitstreams/1336192/retrieve         .

     

    Table 12.1 – First-line ART for patients with active TB and HIV co-infection [2] Citation 2. World Health Organization. Update of recommendations on first- and second-line antiretroviral regimens. Geneva: World Health Organization; 2019.
    https://apps.who.int/iris/rest/bitstreams/1238289/retrieve

     

    ABC: abacavir; AZT: zidovudine; DTG: dolutegravir; EFV: efavirenz; FTC: emtricitabine; LPV/r: lopinavir/ritonavir; RAL: raltegravir; TDF: tenofovir disoproxil fumarate; 3TC: lamivudine

     

    Patients

    First choice

    Main alternatives

    Neonates

    AZT + 3TC + RAL (a) Citation a. Doses of DTG and RAL should be doubled in patients taking rifampicin.

    AZT + 3TC + LPV/r (b) Citation b. LPV/r paediatric formulation can be administered to children as of the age of 2 weeks. (c) Citation c. LPV/r should not be used in children taking bedaquiline. The dose of LPV/r should be adjusted in neonates and children taking rifampicin.

    Children

    ABC + 3TC + DTG (a) Citation a. Doses of DTG and RAL should be doubled in patients taking rifampicin.

    If paediatric DTG not available:

    ABC + 3TC + LPV/r (c) Citation c. LPV/r should not be used in children taking bedaquiline. The dose of LPV/r should be adjusted in neonates and children taking rifampicin.

    ABC + 3TC + RAL (d) Citation d. RAL should be used only if LPV/r paediatric formulation is not available.

    Adolescents and adults

    Childbearing-aged and pregnant women

    TDF + 3TC (or FTC) + DTG

     

    TDF + 3TC (or FTC) + EFV

    ABC + 3TC + DTG

    AZT + 3TC + EFV

    12.2.2 Latent tuberculosis infection

    For patients with LTBI not yet on ART, the initiation of ART should take priority over the initiation of LTBI treatment. See Chapter 16.

     
    • (a) Doses of DTG and RAL should be doubled in patients taking rifampicin.
    • (b)LPV/r paediatric formulation can be administered to children as of the age of 2 weeks.
    • (c) LPV/r should not be used in children taking bedaquiline. The dose of LPV/r should be adjusted in neonates and children taking rifampicin.
    • (d)RAL should be used only if LPV/r paediatric formulation is not available.
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