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TB Treatment for Persons with HIV						Español (Spanish)							Print
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										People with HIV who also have either latent TB infection or TB disease can be treated effectively. The first step is to ensure that people with HIV are tested for TB infection. If found to have TB infection, further tests are needed to rule out TB disease. The next step is to start treatment for latent TB infection or TB disease based on test results.
Fortunately, there are several treatment options for people living with HIV who also have latent TB infection or TB disease. Consult with your health care provider or state or local health department for treatment options.
**Latent TB Infection and HIV**
Someone with untreated latent TB infection and HIV infection is **much more** likely to develop TB disease during his or her lifetime than someone without HIV infection. There are several effective latent TB treatment regimens available for people with HIV. Health care providers should prescribe the more convenient shorter regimens, when possible, as patients are more likely to complete shorter treatment regimens.
Twelve weeks of once-weekly isonaizid and rifapentine (3HP), given by self-administered therapy or directly observed therapy, is the newest CDC-recommended treatment regimen for persons with latent TB infection and HIV and who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine.
Four months of daily rifampin is another treatment option. This regimen should not be used in people with HIV who are taking some combinations of antiretroviral therapy. In situations where rifampin cannot be used, sometimes another drug, rifabutin, may be substituted.
For those taking antiretroviral medications with clinically significant drug interactions with once-weekly rifapentine or daily rifampin, nine months of daily isoniazid is an alternative treatment.Refer to Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV for more information on the drug interactions.
**TB Disease and HIV**
There are two treatment regimen options for TB disease in adults infected with HIV
4-month rifapentine-moxifloxacin TB treatment regimen
Interim Guidance: 4-Month Rifapentine-Moxifloxacin Regimen for the Treatment of Drug-Susceptible Pulmonary Tuberculosis — United States, 2022. *MMWR Morb Mortal Wkly Rep*, 2022
Frequently Asked Questions (FAQs) on a 4-month rifapentine-moxifloxacin TB treatment regimen
6- or 9-month RIPE TB Treatment Regimen
Treatment of Drug-Susceptible Tuberculosis. *Clin Infect Dis*, 2016
Table 3. Doses of Antituberculosis Drugs for Adults and Children*Note: this table is an excerpt from**Treatment of Drug-Susceptible Tuberculosis* *and cites supporting information available in the complete guidelines.*
Highlights from the 2016 Treatment of Drug-Susceptible Tuberculosis Guidelines**4-month Rifapentine-moxifloxacin TB Treatment Regimen**
The 4-month rifapentine-moxifloxacin TB treatment regimen consists of
high-dose daily rifapentine (RPT) with
moxifloxacin (MOX),
isoniazid (INH), and
pyrazinamide (PZA).The 4-month rifapentine-moxifloxacin regimen consists of
An **intensive phase** of 8 weeks, followed by
A **continuation phase** of 9 weeks (total 17 weeks for treatment).The 4-month rifapentine-moxifloxacin regimen is a treatment option for people with HIV with CD4 counts at or above 100 cells/microliter (μL), who are receiving or planning to start efavirenz as part of their antiretroviral therapy (ART) regimen in the absence of any other known drug-drug interactions between antituberculosis and antiretroviral medications.
**6- to 9-month RIPE TB Treatment Regimens**
The 6- to 9-month RIPE TB treatment regimens consist of
**R**ifampin (RIF),
**I**soniazid (INH),
**P**yrazinamide (PZA), and
**E**thambutol (EMB)RIPE regimens consist of
An **intensive phase**of isoniazid (INH), a rifamycin (see Drug Interactions below), pyrazinamide (PZA), and ethambutol (EMB) for the first 2 months followed by
A **continuation phase**of INH and a rifamycin for the last 4 months.**Once-weekly INH and rifapentine in the continuation phase should not be used in any patient infected with HIV.**
Six months should be considered the minimum duration of treatment for adults with HIV, even for patients with culture-negative TB. In the uncommon situation in which HIV-infected patients do NOT receive antiretroviral therapy during TB treatment, prolonging treatment to 9 months (extend continuation phase to 7 months) is recommended. Prolonging treatment to 9 months (extend continuation phase to 7 months) for HIV-infected patients with delayed response to therapy (e.g., culture positive after 2 months of treatment) should be considered.
**Drug-Resistant TB and HIV**
Treatment of drug-resistant TB in persons with HIV infection is the same as for patients without HIV; however, management of HIV-related TB requires expertise in the management of both HIV and TB.
**Antiretroviral Therapy During TB Treatment**
For persons with HIV who are not already on ART, treatment for HIV should be initiated during treatment for TB disease, rather than at the end, to improve outcomes among TB patients co-infected with HIV. Anti-retroviral therapy should ideally be initiated within the first 2 weeks of TB treatment for patients with CD4 cell counts <50/mm3 and by 8-12 weeks of TB treatment initiation for patients with CD4 cell counts ≥50/mm3.  An important exception is HIV-infected patients with TB **meningitis**, in whom antiretroviral therapy **should not** be initiated in the first 8 weeks of anti-tuberculosis therapy.
**Drug Interactions**
Rifamycins (a category of drugs for TB disease and latent TB infection treatment) can interact with certain medicines (antiretrovirals) used to treat HIV. One concern is the interaction of rifampin (RIF) with certain antiretroviral agents (some protease inhibitors [PIs] and nonnucleoside reverse transcriptase inhibitors [NRTIs]). Rifabutin, which has fewer problematic drug interactions, may be used as an alternative to RIF for HIV-infected patients.
As new antiretroviral agents and more pharmacokinetic data become available, these recommendations on managing interactions are likely to be modified. Visit Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis and Guidelines for the use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents for the most recent recommendations.
**Case Management**
Directly observed therapy (DOT) and other adherence promoting strategies should be used in all patients with HIV-related TB. CDC recommends video DOT (vDOT) as an equivalent alternative to in-person DOT for patients on treatment for TB.
The care for HIV-related TB should be provided by, or in consultation with, experts in management of both TB and HIV. The care for persons with HIV-related TB should include close attention to adherence to both regimens of TB and antiretroviral treatment, drug-drug interactions, paradoxical reaction or Immune Reconstitution Inflammatory Syndrome (IRIS), side effects for all drugs used, and the possibility of TB treatment failure or relapse.Related LinksState TB Control Offices
Fact Sheets on TB and HIV/AIDS**For Patients**
Take steps to control TB when you have HIV(Pamphlet)
Tuberculosis – The Connection between TB and HIV (The AIDS Virus) (Pamphlet)
TB and HIV Coinfection (Video)
Questions and Answers About TB
12-Dose Regimen for Latent TB Infection-Patient Education Brochure
12-Dose Regimen for Latent TB Infection-Medication Tracker and Symptom Checklist**For Health Care Providers**
Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis
TB and HIV/AIDS Guidelines
TB Treatment Guidelines
Frequently Asked Questions (FAQs) on a 4-month rifapentine-moxifloxacin TB treatment regimen
Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV
Update on Recommendations for Use of Once-weekly Isoniazid-Rifapentine Regimen to Treat Latent *Mycobacterium tuberculosis* Infection
Guidelines for the use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
							
					
							Last Reviewed:  March 22, 2023						Source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
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