While guidelines are clear about the need to treat tuberculosis (TB) in the setting of human immunodeficiency virus (HIV) infection, the reality is that many patients with HIV/TB co-infection do not receive high-quality TB treatment. The barriers to effective management of TB disease in the setting of HIV are present throughout the care cascade. Recognizing and diagnosing TB is difficult in the presence of HIV, leading to reluctance to initiate empiric treatment. Further, difficulties in drug susceptibility testing may impede the use of regimens for multi-drug resistance tuberculosis (MDR-TB). Then, if the decision to initiate TB treatment is taken, regimens must be appropriately designed: drug-drug interactions must be accounted for; drugs must be available. Finally, the treatment period itself is full of pitfalls, including immune reconstitution inflammatory syndrome (IRIS), heavy pill burdens and unpleasant side effects of combined HIV/TB treatment, all combining to leading to less than full adherence.
Strategies to overcome these barriers need to be discussed and shared among health care providers. This Expert Panel will seek to explore these solutions and disseminate them within the MDR-TB and HIV communities on GHDonline.
We are pleased to welcome the following panelists for this discussion:
- Junior Bazile, MD, MPH, Consultant in Health Systems and Institutional Capacity Development, The Bassiouni Group
- Riitta Dlodlo, MD, DMCH, MPH, Director, Department of Tuberculosis and HIV, the Union
- Serena Koenig, MD, MPH, Associate Physician, Brigham and Women’s Hospital (Division of Global Health Equity, and Division of Infectious Disease); Senior advisor, GHESKIO (Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections); Assistant Professor, Harvard Medical School
- Dylan Tierney, MD, MPH, Associate Physician, Brigham and Women's Hospital
During our week-long discussion, panelists will address the following questions:
1. When is empiric TB treatment indicated in patients with HIV infection and how should possible drug resistance be accounted for in regimen design?
2. To what degree can diagnostic tests be expected to provide a microbiologic diagnosis of TB disease in the setting of HIV co-infection?
3. How should regimens for the co-treatment of HIV and TB be formulated to reduce pill burdens and avoid drug-drug interactions and compounded side effects?
4. What are best practices for managing IRIS?
5. What specific strategies can be used by community health workers to improve adherence to HIV and TB co-treatment?
We encourage you to join the conversation and share your comments and questions with the community.