Treatment of Tuberculosis in HIV-Positive Persons.
Management of tuberculosis is complex in patients with concomitant HIV disease. Experts in the management of both tuberculosis and HIV disease should be involved in the care of such patients. The CDC has published detailed recommendations for the treatment of tuberculosis in HIV-positive patients The basic approach to HIV-positive patients with tuberculosis is similar to that detailed above for patients without HIV disease.
Additional considerations in HIVpositive patients include: (1) longer duration of therapy and (2) drug interactions between rifamycin derivatives such as rifampin and rifabutin used to treat tuberculosis and some of the protease inhibitors and nonnucleoside reverse transcriptase inhibitors (NNRTIs), used to treat HIV (see http://www.cdc.gov/tb/). DOT should be used for all HIV-positive tuberculosis patients. Pyridoxine (vitamin B6), 25–50 mg orally each day, should be administered to all HIV-positive patients being treated with isoniazid to reduce central and peripheral nervous system side effects.