Treatment of TB/HIV Co-infected Patients

Special consideration is required when managing patients with TB/HIV co-infection.

Table 7.7: Special Considerations for ART in TB/HIV Co-infected Patients

Additional Considerations in TB Treatment

Pregnancy and Breastfeeding

• Anti-TB medicines are generally safe during pregnancy and breastfeeding.

• Pregnant women should continue appropriate TB treatment under medical supervision.

TB Preventive Treatment (TPT)

TPT should be offered to:

• Household contacts under 5 years of age of bacteriologically confirmed pulmonary TB cases who do not have active TB.

• All people living with HIV (PLHIV) who do not have active TB.

Dosage of TPT

Adults and Adolescents

• Isoniazid (PO) 300 mg once daily for 6 months.

Children

• Isoniazid (PO) 10 mg/kg/day (range: 10–15 mg/kg/day) for 6 months.

Breastfeeding Infants

• Infants born to mothers with pulmonary TB should receive:

  • Isoniazid preventive therapy (INH) 5 mg/kg/day for 6 months.

  • Bacillus Calmette–Guérin (BCG) vaccination after completion of INH preventive therapy.

Oral Contraceptives

• Rifampicin reduces the effectiveness of oral contraceptives.

• Alternative or additional contraceptive methods should be advised.

Liver Disease

• Most anti-TB medicines may cause hepatotoxicity.

• If jaundice develops:

  • Stop anti-TB medicines immediately.

  • Restart treatment once jaundice resolves.

• In severely ill patients:

  • Start treatment with moxifloxacin and ethambutol only until liver function improves.

Renal Failure

• Ethambutol is excreted through the kidneys.

• It should either:

  • Be avoided, or

  • Be given at a reduced dose in patients with renal impairment.

7.2 General Treatment of Leprosy

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It primarily affects:

• The skin

• Peripheral nerves

• Mucous membranes

Leprosy remains the most common cause of peripheral neuritis worldwide.

Clinical Presentation

Diagnosis of leprosy is based on the presence of at least one of the following cardinal signs:

• Skin patch with loss of sensation

• One or more enlarged peripheral nerves

• Positive skin smear for leprosy bacilli

Classification of Leprosy

Multibacillary (MB) Leprosy

• Six or more skin lesions

• Positive skin smear

Paucibacillary (PB) Leprosy

• One to five skin lesions

• Negative skin smear

Pharmacological Treatment of Leprosy

Patients should be treated using multidrug therapy (MDT). Dosage depends on:

• Classification of leprosy

• Age of the patient

Table 7.8 Treatment of Leprosy

7.2.1 Treatment of Leprosy in Special Cases

Tuberculosis Co-infection

Patients with both tuberculosis and leprosy should receive:

• Full anti-tuberculosis treatment according to TB guidelines.

• Multidrug therapy (MDT) for leprosy concurrently.

Important Consideration

• Rifampicin should be administered at the dose required for TB treatment during the intensive phase.

• After completion of the intensive phase of TB treatment, the patient should continue monthly rifampicin as part of MDT for leprosy.

Leprosy Reactions

There are two major types of leprosy reactions:

1. Reverse Reaction (Type I Reaction)

2. Erythema Nodosum Leprosum (ENL) – Type II Reaction

(Refer to the Manual for the Management of Tuberculosis and Leprosy in Tanzania for detailed guidance.)

Treatment of Leprosy Reactions

Treatment depends on severity and may include:

• Anti-inflammatory medicines

• Corticosteroids, especially prednisolone, usually given for a prolonged period

Early recognition and treatment of reactions are important to prevent permanent nerve damage and disability.