Multidrug Resistant Tuberculosis in Patients with HIV: Management Considerations within High-Resourced Settings.
Ann Am Thorac Soc. 2019 Jul 31;:
Authors: Wilson JW, Nilsen DM, Marks SM
The management of multidrug-resistant tuberculosis (MDR TB) is notably complex among patients with HIV. TB treatment recommendations typically include very little information specific to HIV and MDR TB, which often is derived from clinical trials conducted in low-resource settings. Mortality rates among patients with HIV and MDR TB remain high. We reviewed the published literature and recommendations to synthesize possible patient management approaches demonstrated to improve treatment outcomes in high-resourced countries for patients with MDR TB and HIV. Approaches to diagnostic testing, impact and timing of antiretroviral therapy (ART) on mortality, anti-MDR TB and antiretroviral drug interactions and the potential role for short-course MDR TB therapy are examined. The combination of ART with expanded TB drug therapy, along with the management of immunologic reconstitution inflammatory syndrome (IRIS), other potential HIV-associated opportunistic diseases and drug toxicities, necessitate an integrated multidisciplinary patient care approach utilizing public health case management and provider expertise in drug-resistant TB and HIV management.
PMID: 31365831 [PubMed - as supplied by publisher]