PMID- 27109272
OWN - NLM
STAT- MEDLINE
DCOM- 20171002
LR  - 20171002
IS  - 1601-0825 (Electronic)
IS  - 1354-523X (Linking)
VI  - 22 Suppl 1
DP  - 2016 Apr
TI  - TB-HIV co-infection: a catastrophic comradeship.
PG  - 46-52
LID - 10.1111/odi.12389 [doi]
AB  - The symbiotic association of tuberculosis (TB) and HIV poses a challenge to human 
      survival. HIV complicates every aspect of TB including presentation, diagnosis 
      and treatment. HIV-TB patients encounter unique problems like drug-drug 
      interactions, cumulative toxicity, immune reconstitution inflammatory syndrome 
      (IRIS), lower plasma drug levels and emergence of drug resistance during 
      treatment despite adherence. TB may also be overdiagnosed in HIV due to a number 
      of diseases that closely resemble TB. Notable among them are non-tuberculous 
      mycobacteria, Pneumocystis Jirovecii and Nocardia. Even though diagnostic 
      procedures have improved over the years, patients in developing countries usually 
      seek health care at later stage of the disease. Research data ascertains the 
      duration of therapy for TB to be 6 months with rifampicin and isoniazid, 
      reinforced with ethambutol and pyrazinamide in the first 2 months. The schedule 
      of therapy is still debatable with daily regimens being preferred in the context 
      of HIV. Many reasons exist for persistence of Mycobacterium Tuberculosis (M.TB) 
      in sputum, or delayed-clearance of TB from sputum smears in HIV, apart from 
      emergence of drug resistance and non-compliance. Acquired rifampicin resistance 
      (ARR) is a unique phenomenon complicating HIV-associated TB when an intermittent 
      regimen of antituberculosis therapy (ATT) is used without timely initiation of 
      highly active antiretroviral therapy (HAART), especially in patients harbouring 
      isoniazid-resistant strains Immune restoration is often incomplete ('swiss 
      cheese' pattern) even with effective HAART if not started early. Immune 
      reconstitution inflammatory syndrome (IRIS) is the paradoxical worsening of the 
      patient's condition often with radiological deterioration, due to an enhanced 
      immune response with HAART. IRIS occurs despite an effective virological 
      suppression and a favourable response to ATT. The incidence of IRIS in HIV has 
      reached up to 54%, requiring utilization of experts and tertiary care which forms 
      an obstacle to the decentralization of patients in the ART programme. Research in 
      HIV-TB immunology and management needs further exploration in order to understand 
      the diseases and offer appropriate treatment. The following paragraphs provide 
      scientific evidences generated through research that could potentially guide 
      management.
CI  - (c) 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Narendran, G
AU  - Narendran G
AD  - National Institute for Research in Tuberculosis, Chennai, India.
FAU - Swaminathan, S
AU  - Swaminathan S
AD  - National Institute for Research in Tuberculosis, Chennai, India.
LA  - eng
PT  - Journal Article
PL  - Denmark
TA  - Oral Dis
JT  - Oral diseases
JID - 9508565
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antitubercular Agents)
MH  - Anti-HIV Agents/*therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - Antitubercular Agents/*therapeutic use
MH  - Coinfection/diagnosis/*drug therapy
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/diagnosis/drug 
      therapy/*microbiology/prevention & control
MH  - Tuberculosis, Pulmonary/diagnosis/*drug therapy
OTO - NOTNLM
OT  - ART
OT  - ATT
OT  - HAART
OT  - HIV
OT  - IRIS
OT  - TB
EDAT- 2016/04/26 06:00
MHDA- 2017/10/03 06:00
CRDT- 2016/04/26 06:00
PHST- 2015/02/23 00:00 [received]
PHST- 2015/08/07 00:00 [revised]
PHST- 2015/11/12 00:00 [accepted]
PHST- 2016/04/26 06:00 [entrez]
PHST- 2016/04/26 06:00 [pubmed]
PHST- 2017/10/03 06:00 [medline]
AID - 10.1111/odi.12389 [doi]
PST - ppublish
SO  - Oral Dis. 2016 Apr;22 Suppl 1:46-52. doi: 10.1111/odi.12389.