Are We There Yet? Short-Course Regimens in TB and HIV: From Prevention to Treatment of Latent to XDR TB
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CO-INFECTIONS AND COMORBIDITY (S NAGGIE, SECTION EDITOR)
Are We There Yet? Short-Course Regimens in TB and HIV: From Prevention to Treatment of Latent to XDR TB Elisa H. Ignatius 1 & Susan Swindells 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Despite broad uptake of antiretroviral therapy (ART), tuberculosis (TB) incidence and mortality among people with HIV remain unacceptably high. Short-course regimens for TB, incorporating both novel and established drugs, offer the potential to enhance adherence and completion rates, thereby reducing the global TB burden. This review will outline shortcourse regimens for TB among patients with HIV. Recent Findings After many years without new agents, there is now active testing of many novel drugs to treat TB, both for latent infection and active disease. Though not all studies have included patients with HIV, many have, and there are ongoing trials to address key implementation challenges such as potent drug-drug interactions with ART. Summary The goal of short-course regimens for TB is to enhance treatment completion without compromising efficacy. Particularly among patients with HIV, studying these shortened regimens and integrating them into clinical care are of urgent importance. There are now multiple short-course regimens for latent infection and active disease that are safe and effective among patients with HIV. Keywords HIV infection . Tuberculosis . Drug-susceptible tuberculosis . Drug-resistant tuberculosis . Tuberculosis preventive therapy . Drug-drug interactions
Introduction Despite global access to and uptake of antiretroviral therapy (ART), the proportion of patients with HIV infection and tuberculosis (TB) who die while on treatment is approximately three times that among patients with TB but without HIV (11% versus 4%) [1•]. In 2018, 251,000 people with HIV infection died from TB, the leading infectious killer globally, accounting for one in every three HIV-related deaths [1•]. Given the known risk that these two conditions jointly pose, it is imperative to diagnose TB and HIV early in the course and maximize the This article is part of the Topical Collection on Co-infections and Comorbidity * Susan Swindells [email protected]
likelihood of successful completion of TB treatment, be that for latent TB infection (LTBI), drug-susceptible (DS), or drugresistant (DR) disease. Though some data suggest that adherence to TB treatment is slightly higher among patients with HIV [2], the lengthy duration of therapy remains a major barrier to completion and cure. Additionally, patients with both TB and HIV have additional challenges of potent drug-drug interactions, overlapping toxicities, and risk of immune reconstitution inflammatory syndrome (IRIS) in the weeks to months after treatment begins. After a long drought, the pipeline for new TB drugs is now flowing [3]. There is unprecedented movement towards integrating new drugs into the TB treatment continuum and refining older regimens in order to shorten the
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