Treatment for people with HIV and TB

Treatment for people with tuberculosis (TB) who also have human immunodeficiency virus (HIV) is nearly the same as for people who don't have HIV. But there are some important differences, including:¹

• Checking to make sure that the TB medications are not changing the effectiveness of the medicines used to treat the HIV infection.
• Continuing treatment for longer than 6 months. Treatment may go on for up to 9 months for people with both TB and HIV infections, especially for children.
• Avoiding the once-a-week treatment program when using isoniazid-rifapentine after the first 2 months of TB therapy. Instead, the medicines should be taken every day or 3 times a week.
• Avoiding the twice-a-week treatment program when using isoniazid-rifampin or rifabutin for people whose CD4+ lymphocyte counts are less than 100/µl (100 cells per microliter). Instead, the medicines should be taken every day or 3 times a week.

Treatment of latent TB in people with HIV infection

Experts recommend 9 months of daily treatment with the antibiotic isoniazid to cure a latent TB infection in people with HIV infection. The treatment helps prevent the TB infection from becoming active, meaning it can spread to other people.

Treatment of active TB in people with HIV infection

People who are infected with HIV take a combination of 4 medications daily for 2 months to treat active TB. This is followed by 2 medications daily for the next 4 months.¹

• Appropriate treatment should last for at least 6 months. Treatment may go on longer if tests show that TB-causing bacteria are still present in sputum or in other areas of the body.
• All doses of the antibiotics must be taken. This may require daily visits with a health professional to receive every dose of your medicines. This is called directly observed therapy (DOT), and it improves the cure rate of TB treatment.²
• Doctors may use another medicine instead of rifampin, which can lower the effectiveness of some medicines used to treat HIV infection.

Citations

1. American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America (2003). Treatment of tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167(4): 603-662.

2. Centers for Disease Control and Prevention (1998). Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: Principles of therapy and revised recommendations. MMWR, 47(RR-20): 1-51. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/00055357.htm.