Global guidelines for treatment of tuberculosis among persons living with HIV: unresolved issues

Kumar, A and Kumar, A M V and Gupta, D and Kanchar, A and Mohammed, S and Srinath, S and Tripathy, S and Rajasekaran, S and Chan, P L and Swaminathan, S and Dewan, P K (2012) Global guidelines for treatment of tuberculosis among persons living with HIV: unresolved issues. International Journal of Tuberculosis and Lung Disease, 16 (5). pp. 573-578. ISSN Print: 1027-3719 Electronic: 1815-7920

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Abstract

The Revised National Tuberculosis Control Programme (RNTCP) in India uses a fully intermittent thrice-weekly rifampicin-containing regimen for all tuberculosis (TB) patients, including those who are human immunodeficiency virus (HIV) infected, whereas the World Health Organization (WHO) recommends daily anti-tuberculosis treatment at least during the intensive phase. The WHO recommendation was based on the results of a metaanalysis demonstrating increased risk of recurrence and failure among HIV-infected TB patients receiving intermittent TB treatment compared to a daily regimen. Review of the primary evidence indicates limited, lowquality information on intermittency, mostly from observational studies in the pre-antiretroviral treatment (ART) era. Molecular epidemiology in India indicates that most of the recurrences and many of the failures result from exogenous re-infection, suggesting poor infection control and high transmission rather than poor regimen e fficacy. Subsequently published studies have shown acceptable treatment outcomes among HIV-infected TB patients receiving intermittent anti-t uberculosis regimens with concomitant ART. Treatment outcomes among HIV-infected TB patients treated under programmatic conditions show low failure rates but high case fatality; death has been associated with lack of ART. The highest priority is therefore to reduce mortality by linking all HIV-infected TB patients to ART. While urgently seeking to reduce death rates among HIV-infected TB patients, given the poor evidence for change and operational advantages of an intermittent regimen, the RNTCP intends to collect the necessary evidence to inform national policy decisions through randomised clinical trials.

Affiliation:	ICMR-National Institute for Research in Tuberculosis
Item Type:	Article
Uncontrolled Keywords:	HIV; TB; India; intermittent regimen; ART
Subjects:	Tuberculosis > Clinical Research Tuberculosis > HIV - Basic Science
Divisions:	Clinical Research
Depositing User:	Dr. Rathinasabapati R
Date Deposited:	01 Sep 2022 10:19
Last Modified:	01 Sep 2022 10:19
URI:	http://eprints.nirt.res.in/id/eprint/1151

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