Advances in Antiretroviral Therapy for Patients with Human Immunodeficiency Virus-Associated Tuberculosis

Viruses. 2024 Mar 23;16(4):494. doi: 10.3390/v16040494.

Abstract

Tuberculosis is one of the most common opportunistic infections and a prominent cause of death in patients with human immunodeficiency virus (HIV) infection, in spite of near-universal access to antiretroviral therapy (ART) and tuberculosis preventive therapy. For patients with active tuberculosis but not yet receiving ART, starting ART after anti-tuberculosis treatment can complicate clinical management due to drug toxicities, drug-drug interactions and immune reconstitution inflammatory syndrome (IRIS) events. The timing of ART initiation has a crucial impact on treatment outcomes, especially for patients with tuberculous meningitis. The principles of ART in patients with HIV-associated tuberculosis are specific and relatively complex in comparison to patients with other opportunistic infections or cancers. In this review, we summarize the current progress in the timing of ART initiation, ART regimens, drug-drug interactions between anti-tuberculosis and antiretroviral agents, and IRIS.

Keywords: HIV infection; antiretroviral therapy; immune reconstitution inflammatory syndrome; tuberculosis.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use
  • Anti-Retroviral Agents / adverse effects
  • Anti-Retroviral Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • Antitubercular Agents* / therapeutic use
  • Drug Interactions*
  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • Humans
  • Immune Reconstitution Inflammatory Syndrome*
  • Treatment Outcome
  • Tuberculosis* / complications
  • Tuberculosis* / drug therapy

Substances

  • Antitubercular Agents
  • Anti-HIV Agents
  • Anti-Retroviral Agents