HIV and TB Flashcards
Impact of cART in children
- immunological preservation and restoration
- improved growth
- prevent adverse neurocognitive deficits
- reduction in infectious complications
- preservation of vaccine-induced responses
- reversal of organ-specific complications
- slow/arrest the progression to AIDS
- decreased risk for death/ prolong life expectancy
Criteria for fast-tracking cART (within 7 days of HIV diagnosis)
- children <1 year
- CD4 <15% or <200cell/ul
- WHO stage 4
- MDR/XDR TB
Social criteria for cART
Mandatory
- indentifiable adult who is able to administer medication
Desirable
- demonstrated reliability of caregiver
- previous record of adherence
- ability to attend an antiretroviral treatment centre regularly
disclosure to another adult in the same house
Common antiretrovial agents
- NRTIs (abacavir, lamivudine, emtricitabine)
- NtRTIs (tenofovir)
- NNRTIs (neviropine, efavirenz)
- PIs (lopinavir/ritonavir)
- Integrase inhibitors (reltegravir)
Preferred 1st line regimen fo age <4 weeks
- AZT
- 3TC
- NVP
Preferred 1st line regimen for age 4 weeks-3 years
- ABC
- 3TC
- LPV/r
Preferred 1st line treatment for age 3-15
ABC
3TC
EFV
Preferred 1st line treatment for age 15-20
FDC
TDF
3TC
EFV
How often does VL need to be measured?
- routine monitoring at 6 months and 12 months after starting cART
- then every 12 months
When is VL suppressed?
if <50 copies/ml
Causes of an unsuppressed VL
- infection
- poor adherence
- incorrect dosing
- poor absorption and reduced bioavailability
- adverse drug interactions
- drug resistance
Factors impacting adherence
- socio-demographic factors
- inadequate counselling and education
- care-giver factors
- complex ARV regimen
- side effects
How to improve adherence
- education/ counselling
- patient feedback
- support groups
- simplify medication
- manage side effects
- provide tools
When is viral resistance testing done?
- usually done after failing a PI-containing regimen
Principles of treating drug-susceptible TB
- combo therapy
- short-course regimens comprising both bactericidal and sterilizing activity
- intensive phase achieves rapid reduction of organism load
- continuation phase ensure effective eradication of persistent bacilli
- optimise adherence and minimise adverse effects
Drugs used for susceptible TB
- Isoniazid
- Rifampicin
- Pyrazinamide
- Ethambutol
- Ethionamide
Genes conferring RIF resistance
rpoB
Genes conferring INH resistance
- katG
- inhA
- ahpC
Definition of MDR-TB
Resistance to both INH and RIF
Definition of pre-XDR-TB
Resistance to INH and RIF and either a fluoroquinolone or a second-line injectible
Definition of XDR-TB
Resistance to INH and RIF as well as any fluoroquinolone and any of the second-line anti-TB injectable drugs
Examples of injectable drugs
- Streptomycin
- Kanamycin
- Amikacin
Examples of Fluroquinolones
- Levofloxacin
- Moxifloxacin
Oral 2nd line drugs
- ethionamide
- terizidone
Manifestations of IRIS
- swinging fever
- new/worsening lymphadenitis
- new/worsening pulmonary infilrates and resp failure
- new/worsening pleuritis, pericarditis, ascites
- intracranial tuberculomas
- TBM
- disseminated skin lesions
- hepatosplenomegaly
- soft-tissue absecesses
IRIS
Immune reconsitution inflammatory syndrome
Indications of preventive therapy after TB exposure
- all symptomatic children <5 years of age
- all HIV-infected children
Preventive therapy for drug-susceptible TB contact
Isoniazid 1-mg/kg/day per os for 6 months
Preventive therapy for MDR-TB contact
- isoniazid 15-20mg/kg/day
- ethambutol 20-25mg/kg/day
- levofloxacin 15-20mg/kg/day
for 6 months
