Full Answer
Who should be given priority for initiating antiretroviral therapy for HIV disease?
People with advanced HIV disease should be given priority for initiating ART since they are at high risk of death, particularly if resources are scarce.
When is anti-retroviral therapy indicated in the treatment of tuberculosis (TB)?
Anti-retroviral therapy should ideally be initiated within the first 2 weeks of TB treatment for patients with CD4 cell counts <50/mm3 and by 8-12 weeks of TB treatment initiation for patients with CD4 cell counts ≥50/mm3.
Should HIV treatment be initiated during treatment for TB?
For persons with HIV who are not already on ART, treatment for HIV should be initiated during treatment for TB disease, rather than at the end, to improve outcomes among TB patients co-infected with HIV.
Can antiretroviral treatment as prevention reduce HIV transmission?
Antiretroviral therapy (ART) has been remarkably effective in ameliorating Human Immunodeficiency Virus (HIV)-associated morbidity and mortality. The rapid decline in viral load during ART also presents an opportunity to develop a “treatment as prevention” strategy in order to reduce HIV transmission at a population level.
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4.1. Introduction
In 2016, WHO strongly recommended initiating ART for all adults living with HIV regardless of WHO clinical stage and at any CD4 cell count. This “treat-all” recommendation has resulted in the scale-up of ART in more than 130 countries globally, accompanied by increased levels of availability of treatment monitoring.
4.2. Preparing people living with HIV for ART
Before people start ART, health-care providers should initiate a detailed discussion about their willingness and readiness to initiate ART, the choice of ARV drug regimen, dosage, scheduling, likely benefits, possible adverse effects and required follow-up and monitoring visits.
4.3. What to expect in the first months of ART
Although ART is a lifelong commitment, the first months are especially important.
4.4. When to start ART
ART should be initiated for all people living with HIV regardless of WHO clinical stage and at any CD4 cell count.
4.8. Monitoring ARV toxicity
The availability of laboratory monitoring is not required for initiating ART.
4.9. ARV drug resistance
A high prevalence of pretreatment HIV drug resistance to NNRTIs negatively affects the success of the public health response to HIV and potentially endangers the attainment of the global target to end the AIDS epidemic as a global threat.
4.10. Key ARV drug interactions
Drug interactions can reduce the efficacy of ART and/or increase ART-related toxicity. This section summarizes the major ARV drug interactions. A detailed table on drug interactions is available in the annexes.
When should antiretroviral therapy be initiated?
Anti-retroviral therapy should ideally be initiated within the first 2 weeks ...
How long does HIV treatment last?
In the uncommon situation in which HIV-infected patients do NOT receive antiretroviral therapy during TB treatment, prolonging treatment to 9 months (extend continuation phase to 7 months) is recommended. Prolonging treatment to 9 months (extend continuation phase to 7 months) for HIV-infected patients with delayed response to therapy (e.g., ...
How long does it take to take isonaizid and rifapentine?
Twelve weeks of once-weekly isonaizid and rifapentine (3HP), given by self-administered therapy or directly observed therapy, is the newest CDC-recommended treatment regimen for persons with latent TB infection and HIV and who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine.
What is the first step in HIV testing?
The first step is to ensure that people with HIV are tested for TB infection. If found to have TB infection, further tests are needed to rule out TB disease. The next step is to start treatment for latent TB infection or TB disease based on test results.
Can you take rifabutin with HIV?
Four months of daily rifampin is another treatment option. This regimen should not be used in people with HIV who are taking some combinations of antiretroviral therapy. In situations where rifampin cannot be used, sometimes another drug, rifabutin , may be substituted. For those taking antiretroviral medications with clinically significant drug ...
Is latent TB more likely to develop HIV?
Latent TB Infection and HIV. Someone with untreated latent TB infection and HIV infection is much more likely to develop TB disease during his or her lifetime than someone without HIV infection. There are several effective latent TB treatment regimens available for people with HIV.
Can INH be used in HIV?
Once-weekly INH and rifapentine in the continuation phase should not be used in any patient infected with HIV.