Tuberculosis and HIV/AIDS
It is recommended that HIV+ people get screened for TB once a year using a skin or blood test. The skin test is called a TST (tuberculin skin test) or PPD (purified protein derivative). A small amount of "tuberculin" (a TB protein) is injected under the skin of the arm, and the test is "read" 2-3 days later, by a health care worker who looks at the spot on the arm and measures any swelling. The test is positive if the area develops a hard swelling under the skin that is bigger than 5mm.
There is also a TB blood test, called an IGRA (interferon-gamma release assay), which measures your immune response to TB. Because HIV+ people sometimes do not develop a positive TB skin test reaction even if they are infected, the TB blood test is now the preferred test for those living with HIV. An added benefit to the IGRA test is that there is no need to return to a health clinic; results are usually available within 24 hours and can be communicated by phone.
A positive TB skin or blood test shows that you have been exposed to TB, but it does not mean you have active TB disease. Your health care provider will look at your symptoms as well as other tests, such as chest X-rays and sputum tests, before diagnosing you with active TB disease.
There are two types of treatment for TB:
HIV+ people who have latent or inactive TB can be treated with TB drugs to prevent them from developing active disease. The usual treatment includes taking an antibiotic called isoniazid (INH) with pyridoxine (vitamin B6) once or twice weekly for nine months. However, the CDC now also recommends a combination of INH and rifapentine taken once a week for 12 weeks while directly observed. With directly observed therapy (DOT), a nurse, outreach worker, or family member watches the person with TB take her or his pills each week. The 12 week DOT regimen is NOT recommended for HIV+ people taking antiretroviral therapy. Your health care provider will help you decide which treatment option is best for you.
Treatment of Active Disease
Treatment of active TB requires combination therapy. The usual regimen is:
These four drugs are taken daily for two months. Tests can be done to see how well the drugs are fighting the TB. If the drugs are fighting the TB well, treatment changes to just isoniazid plus rifampin for four more months.
TB drugs can cause some side effects. For example, isoniazid can cause nerve damage (peripheral neuropathy) or liver damage, and ethambutol can cause vision problems. It is important not to drink alcohol while taking isoniazid, or you can badly damage your liver. Pyridoxine (vitamin B6) may be given with INH to prevent nerve damage from this drug.
Some TB drugs can interact with HIV drugs. Rifampin, for example, can interfere with protease inhibitors and non-nucleoside reverse transcriptase inhibitors. This can make it difficult to treat both diseases at the same time. If you are taking a protease inhibitor, your health care provider may make changes to your TB drugs. Your provider may also adjust your drug doses when you are being treated for both TB and HIV. Some HIV+ people may need longer TB treatment than people without HIV.
As with HIV, taking your TB drugs exactly as prescribed (good adherence) is very important. The full course of treatment must be completed, even if you feel better before you have finished taking all your drugs (symptoms usually improve after 3-4 weeks). This helps prevent TB from coming back and becoming resistant to drugs.
Drug Resistant TB
Like HIV, TB can change to become resistant to drugs, especially if a drug is used alone. This can cause the drugs to stop working. Therefore, it is important for your provider to test your TB for drug resistance. Drug-resistant tuberculosis (DR TB) must be treated with a combination of drugs. Some TB strains are now resistant to several different drugs. These strains are called multiple-drug resistant tuberculosis (MDR TB) and extensively-drug resistant tuberculosis (XDR TB). XDR TB is resistant to almost all medications used to treat TB. As a result, many more people with XDR TB die or have treatment failure.
According to the CDC, untreated TB is a greater threat to pregnant women and their babies than TB treatment. Therefore, it is important to screen for and treat TB in pregnant women. Both the TB skin test and the TB blood test are safe during pregnancy. As with anyone who is not pregnant, additional tests are needed to determine if someone who tests positive for TB with a skin or blood test has active TB disease.
For pregnant women with latent or inactive TB, INH taken once or twice weekly for 9 months is the usual treatment. It is important for pregnant women taking INH to take pyridoxine (vitamin B6) to help prevent nerve damage. The 12-week regimen of INH plus rifapentine is NOT currently recommended for women who are pregnant or who expect to become pregnant in the next 3 months.
In pregnant women with active TB disease, the usual treatment is INH, rifampin, and ethambutol daily for 2 months followed by INH plus rifampin for 7 months (for a total of 9 months of treatment). Pregnant women should not take streptomycin because it can cause deafness in babies. Pyrazinamide is most often not recommended during pregnancy, as its effects on the developing baby are not yet known. Other TB drugs that should be avoided during pregnancy include: kanamycin, amikacin, capreomycin, and fluoroquinolones (an entire group or type of antibiotics).
TB is a serious disease that is the leading cause of death in HIV+ people worldwide. Many people can keep TB under control and have latent, or inactive, disease. But people with weakened immune systems, including HIV+ people, are much more likely to develop active TB disease that needs treatment. In many ways, TB and HIV treatment are similar. Both diseases must be treated with a combination of drugs, since using only one drug can lead to resistance. With both TB and HIV, good adherence is an important factor in successful treatment. But unlike HIV, TB can usually be completely cured after less than a year of treatment.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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