Current trends and intricacies in the management of HIV-associated pulmonary tuberculosis
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AIDS Research and Therapy Open Access
REVIEW
Current trends and intricacies in the management of HIV‑associated pulmonary tuberculosis Narendran Gopalan, Padmapriyadarsini Chandrasekaran, Soumya Swaminathan and Srikanth Tripathy*
Abstract Human immunodeficiency virus (HIV) epidemic has undoubtedly increased the incidence of tuberculosis (TB) globally, posing a formidable global health challenge affecting 1.2 million cases. Pulmonary TB assumes utmost significance in the programmatic perspective as it is readily transmissible as well as easily diagnosable. HIV complicates every aspect of pulmonary tuberculosis from diagnosis to treatment, demanding a different approach to effectively tackle both the diseases. In order to control these converging epidemics, it is important to diagnose early, initiate appropriate therapy for both infections, prevent transmission and administer preventive therapy. Liquid culture methods and nucleic acid amplification tests for TB confirmation have replaced conventional solid media, enabling quicker and simultaneous detection of mycobacterium and its drug sensitivity profile Unique problems posed by the syndemic include Acquired rifampicin resistance, drug–drug interactions, malabsorption of drugs and immune reconstitution inflammatory syndrome or paradoxical reaction that complicate dual and concomitant therapy. While the antiretroviral therapy armamentarium is constantly reinforced by discovery of newer and safer drugs every year, only a few drugs for anti tuberculosis treatment have successfully emerged. These include bedaquiline, delamanid and pretomanid which have entered phase III B trials and are also available through conditional access national programmes. The current guidelines by WHO to start Antiretroviral therapy irrespective of CD4+ cell count based on benefits cited by recent trials could go a long way in preventing various complications caused by the deadly duo. This review provides a consolidated gist of the advancements, concepts and updates that have emerged in the management of HIV-associated pulmonary TB for maximizing efficacy, offering latest solutions for tackling drug–drug interactions and remedial measures for immune reconstitution inflammatory syndrome. Keywords: HIV, TB, ATT, ART, IRIS, MDR-TB, IPT Background HIV and tuberculosis (TB) have always been faithful comrades facilitating each other in spreading across the globe. According to recent World Health Organization (WHO) estimates, 9.6 million cases of tuberculosis (TB) occurred all over the world with 12 % (1.2 million) being co-infected with human immunodeficiency virus (HIV); with 37 % of these new TB cases going undiagnosed [1]. In the year 2014, an estimated 1.5 million had died due to *Correspondence: [email protected] Division of HIV, National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai 600 031, India
TB with a quarter of them caused by HIV. Pulmonary TB is the commonest form of TB even in HIV even t
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