guidelines developed by IDSA, the American Thoracic Society (ATS) and Centers
for Disease Control and Prevention (CDC) state that simultaneous treatment of
HIV and tuberculosis (TB) saves lives. The guidelines on the treatment of
drug-susceptible TB are now available in Clinical
HIV or diabetes, who are taking immune-suppressing medications, or who smoke or
abuse drugs are at higher risk for developing TB disease once infected.
Patients often are diagnosed with HIV and TB at the same time. In 2003, when
previous TB guidelines were developed, patients with HIV usually did not start
anti-retroviral therapy (ART) until after TB treatment was completed, unless
the immunosuppression from HIV-infection progressed. Recommendations for timing
of ART initiation have since changed. The new guidelines are intended for use
in the United States and other areas with similar diagnostic and management resources
and replace the 2003 guidelines published in CDC’s Morbidity and Mortality
Weekly Review (MMWR).
do not receive ART during treatment of TB, the new guidelines recommend that TB
treatment should be extended to eight months or longer, to reduce risk of
decades of steady declines, the number of new TB cases in the US rose slightly
in 2015, according to provisional data released by CDC. TB is one of the
world’s deadliest diseases: in 2014, it is estimated that 9.6 million people
worldwide fell newly ill with TB, and 1.5 million died.
guidelines recommend comprehensive care of all patients with TB disease (known
as case management), including the use of directly observed therapy (DOT),
which improves treatment success. To be consistent with the principles of
patient-centered care, the guidelines recommend that decisions regarding the
use of DOT be made in partnership with the patient. DOT should be provided by
trained health care workers in the doctor’s office, clinic, or the patient’s
home, place of employment, school or other site convenient for the
patient. For all TB patients, case management is essential to ensure
treatment is effective, the guidelines note.
guidelines focus on drug-susceptible TB, following the recommendations can help
stem the growing problem of acquired drug resistance, researchers note. This
includes recommendations related to avoiding highly intermittent therapies, and
using case management strategies such as DOT.
killing of the TB bacteria reduces the risk of death and the spread of the
disease, the guidelines note that TB treatment (currently a combination of four
medications) should begin as soon as the patient is suspected of having active
TB disease, even before test results confirm the diagnosis. They also recommend
therapy be given daily, rather than intermittently.
guidelines panel included: Payam Nahid, MD, MPH, lead author of the guidelines;
Andrew Vernon, MD; Susan E. Dorman, MD; Narges Alipanah, MD; Pennan M. Barry,
MD, MPH; Jan L. Brozek, MD, PhD; Adithya Cattamanchi, MD, MAS; Lelia H.
Chaisson, MPH; Richard E. Chaisson, MD, FIDSA; Charles L. Daley, MD; Malgosia
Grzemska, MD, PhD; Julie M. Higashi, MD; Christine S. Ho, MD; Philip C.
Hopewell, MD; Salmaan A. Keshavjee, MD, PhD; Christian Lienhardt, MD; Richard
Menzies, MD; Cynthia Merrifield, RN; Masahiro Narita, MD; Rick O’Brien, MD;
Charles A. Peloquin, PhD; Ann Raftery, RN; Jussi Saukkonen, MD; H. Simon
Schaaf, MD; Giovanni Sotgiu, MD; Jeffrey R. Starke, MD, FIDSA; and Giovanni
Battista Migliori, MD.
guidelines are also endorsed by the European Respiratory Society (ERS) and US
National Tuberculosis Controllers Association (NCTA).
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