Abstract

HUMAN IMMUNODEFICIENCY VIRUS ASSOCIATED TUBERCULOSIS

Sereena Saju, PharmD*, A.S. Ezhilarasi, PharmD, Mancy Jose Mattam, PharmD, Mehnaaz Anjum. H, PharmD, M. Vani, M. Pharm., Ph.D., Meena, M. Pharm., Ph.D.

ABSTRACT

The association of tuberculosis (TB) with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) over the past many years has become a rising syndemic. Co-infection with HIV provokes challenges in identification and treatment of tuberculosis. Further, there has been a rise in rates of drug resistant TB, including multi-drug resistant TB (MDR-TB) and extensively drug resistant TB (XDRTB), which poses a troublesome in treatment thus, contributing to increased mortality. HIV complicates every aspects of TB including presentation, diagnosis and treatment. HIV-TB coinfected patients encounters distinctive issues like drug–drug interactions, additive toxicity, lower plasma drug levels, suboptimal adherence and emergence of drug resistance, particularly immune reconstitution inflammatory syndrome (IRIS). Moreover, poor performance of sputum smear microscopy resulted in inadequate diagnosis of HIV-infected patients, newer diagnostic measures are urgently needed that not only seem to be solely sensitive and specific, however, easy to use in remote and resource-constrained settings. Linkage of co-infected patients to antiretroviral treatment centres is crucial if early mortality is to be prevented. This review focuses on the epidemiology, etiology, pathophysiology, clinical aspects, diagnosis of HIV-associated TB and summarizes World Health Organisation (WHO) recommendations for treatment.

Keywords: Co-infection, Xpert MTB Rif, tuberculous granulomas, antiretroviral therapy, drug resistance, infection control.