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TB treatment for HIV patients

TB treatment for HIV patients

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TB treatment for HIV patients

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  1. TB treatment for HIV patients Capacity Building for Tuberculosis control, with a specific focus on TB/HIV in CAREC Member Countries

  2. First line anti-TB drugs

  3. Population of TB bacilli • Metabolically active I • Bacilli inside cells (macrophages) P • Semidormant bacilli (persisters) R • Dormant bacilli

  4. Standardized regimens

  5. Monitoring of patients with SS (+)

  6. Action in interruption of TB treatment

  7. Action in interruption of TB treatment

  8. GDF standard treatment kit

  9. Sample regimens with fixed dose combination of anti TB drugs in adults

  10. Calculation of drug requirements • Calculate drug requirements to treat ONE patient for each category • Multiply by the number of patients you are expecting this year for each category • Multiply by 2 for 1 year of reserve stock • Subtract current stock • Amounts needed after subtracting current stock

  11. Calculation of drug requirements *Tablets needed to treat: Category I: a patients x b tablets Category II: c patients x d tablets Category III: e patients x f tablets

  12. TB treatment for PLWHA

  13. PERU: decrease of the fatality rate in co-infected patients. Early detection and DOTS Fuente: Ministerio de Salud, PNCT Perú.

  14. TB treatment for PLWHA The same categories for TB patients irrespective HIV status

  15. Standardized regimens

  16. Implications of HIV for TB treatment in PLWHA • Treatment is the same, except for the use of Thioacetazone • Increased risk of adverse drug reactions • Monitor to identify and treat O I during TB treatment • Increased case fatality rate, but response in survivors is similar to HIV (-) patients • Recurrence of TB after completion of treatment is higher in HIV (+): 5-10% • Risk of developing resistance to R, if CD4 < 100 /mm3 • Drug interactions: R with ARV

  17. Drug interactions: R with ARV • Mechanism: R stimulates the activity of cytochrome P450 liver enzyme system. • P450 liver enzyme system metabolizes PIs and NNRTIs • PIs: SQV, RTV, IDV, NFV • NNRTIs: NVP, EFV, DLV

  18. When start ARV treatment in TB patients?

  19. Immune reconstitution syndrome • Developed in up to 36% of patients if ART • 7% if no ART • Fever, worsening chest infiltrates in X Ray and peripheral and mediastinal lymphadenopathy. • Lower VL, increase reactivity to PPD • Generally, self-limited, and last 10 - 40 days. • If the reaction is severe: short course of corticoid Source: Havlir et Barnes, 1999. NEJM

  20. Thank you!