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Table 4. Regimen Options for Treatment of HIV-Related TB Disease, 2000

Total Duration (months) Induction Phase Continuation Phase Considerations for HIV Therapy Comments
Drugs Interval/ Duration Drugs Interval/ Duration
61 INH, RFB, PZA2, EMB2 Daily for 2 months (8 weeks)

or

Daily for 2 weeks and then 21 times/week for 6 weeks

INH, RFB Daily or 2 times/week for 4 months (18 weeks)

or

2 times/week for 4 months (18 weeks)

Concurrent administration of rifabutin is contraindicated with hard-gel saquinavir and delavirdine.

20%-25% increase in the dose of PIs or NNRTIs might be necessary. 

Patient should be monitored carefully for RFB drug toxicity (arthralgia, uveitis, leukopenia) if RFB is used concurrently with PIs or NNRTIs.

Evidence of decreased antiretroviral drug activity should be assessed periodically with HIV RNA levels.

No contraindication exists for the use of RFB with NRTIs.

If the patient is also taking nelfinavir, indinavir, amprenavir, or ritonavir, the daily dose of RFB is decreased from 300 mg to 150 mg, and to 150 mg two or three times a week when used with ritonavir. The twice-weekly dose of RFB (300 mg) remains unchanged if the patient is also taking these PIs.

If the patient is also taking efavirenz, the daily dose of RFB is increased from 300mg to 450mg or 600mg.

Thrice-weekly dosing for RFB has not been studied and cannot be currently recommended.

91 INH, SM, PZA, EMB Daily for 2 months (8 weeks)

or

Daily for 2 weeks and then 21 times/week for 6 weeks

INH, SM, PZA 2-3 times/week for 7 months (30 weeks)

or

2-3 times/week for 7 months (30 weeks)

Can be used concurrently with antiretroviral regimens that include PIs, NRTIs, and NNRTIs. SM is contraindicated for pregnant women.

Every effort should be made to continue administering SM for the total duration of treatment. When SM is not used for the recommended 9 months, EMB should be added to the regimen and the treatment duration should be prolonged from 9 months (38 weeks) to 12 months (52 weeks).

61 INH, RIF, PZA3, EMB3 or SM Daily for 2 months (8 weeks)

or

Daily for 2 weeks and then 2-3 times/week for 6 weeks

INH, RIF Daily or 2-3 times/ week for 4 months (18 weeks)

or

Daily for 2-3 times/week for 4 months (18 weeks)

Rifampin can be used for the treatment of active TB disease for patients whose antiretroviral regimen includes
  • The NNRTI efavirenz and two nucleoside reverse transcriptase inhibitors (NRTIs);
  • The protease inhibitor ritonavir and one or more NRTIs; or
  • The combination of two protease inhibitors (ritonavir and either saquinavir hard-gel capsule or saquinavir soft-gel capsule).
NTRIs may be administered concurrently with RIF.

If appropriate, patients should be assessed every 3 months to evaluate the decision to initiate antiretroviral therapy.

A 2-week "P-450 induction wash-out" period may be necessary between the last dose of RIF and the first dose of protease inhibitors or NNRTIs

 

SM is contraindicated for pregnant women.
61 INH, RIF, PZA, EMB3 or SM3

 

3 times/ week for 2 months (8 weeks) INH, RIF, PZA,EMB or SM

 

 3 times/ week for 4 months (18 weeks)

Footnotes

EMB = ethambutol, INH = isoniazid, PZA = pyrazinamide, RFB = rifabutin, RIF = rifampin, SM = streptomycin, PIs = protease inhibitors, NNRTIs = nonnucleoside reverse transcriptase inhibitors, NRTIs = nucleoside reverse transcriptase inhibitors

  1. Duration of therapy should be prolonged for patients with delayed response to therapy. Criteria for delayed response should be assessed at the end of the 2-month induction phase and include a) lack of conversion of the Mycobacterium tuberculosis culture from positive to negative or b) lack of resolution or progression of signs or symptoms of TB.
  2. Continue PZA and EMB for the total duration of the induction phase (8 weeks).
  3. Continue PZA for the total duration of the induction phase (8 weeks). EMB can be stopped after susceptibility test results indicate Mycobacterium tuberculosis susceptibility to INH and RIF.

Note: Directly observed therapy (DOT) is recommended for all TB treatment regimens.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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