Multidrug Resistant Tuberculosis in Patients with HIV: Management Considerations within High-Resourced Settings

Details

• Alternative Title:
  Ann Am Thorac Soc
• Personal Author:
  Wilson, John W. ; Nilsen, Diana M. ; Marks, Suzanne M.
• Description:
  The management of multidrug-resistant tuberculosis (MDR TB) is notably complex among patients with human immunodeficiency virus (HIV). TB treatment recommendations typically include very little information specific to HIV and MDR TB, which often is derived from clinical trials conducted in low-resource settings. Mortality rates among patients with HIV and MDR TB remain high. We reviewed the published literature and recommendations to synthesize possible patient management approaches demonstrated to improve treatment outcomes in high-resourced countries for patients with MDR TB and HIV. Approaches to diagnostic testing, impact and timing of antiretroviral therapy on mortality, anti-MDR TB and antiretroviral drug interactions, and the potential role for short-course MDR TB therapy are examined. The combination of antiretroviral therapy with expanded TB drug therapy, along with the management of immune reconstitution inflammatory syndrome, other potential HIV-associated opportunistic diseases, and drug toxicities, necessitate an integrated multidisciplinary patient care approach using public health case management and provider expertise in drug-resistant TB and HIV management.
• Keywords:
  Anti-Retroviral Agents Antitubercular Agents Case Management Drug Interactions Health Resources HIV HIV Infections Humans MDR TB Tuberculosis Tuberculosis, Multidrug-Resistant

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• Source:
  Ann Am Thorac Soc. 17(1):16-23
• Pubmed ID:
  31365831
• Pubmed Central ID:
  PMC6938532
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  17
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:0ae6c9f7b613f6b632dbd99f1f13811f5c7f9f59c78ee564979ae5ecb9ecbcb3
• Download URL:
  https://stacks.cdc.gov/view/cdc/83987/cdc_83987_DS1.pdf
• File Type:
  [PDF - 331.08 KB ]