Abstract
Since 1990 the HIV epidemic in South Africa has had a huge impact on the burden of tuberculosis (TB) especially within poor communities where annual notification rates have risen as high as 1 500/100 000 population.1 Not surprisingly as antiretroviral treatment (ART) clinics have been established in these communities TB has emerged as a key clinical problem within these services. A large proportion of patients at programme enrolment have a history of treated TB or active TB or develop TB during ART. Patients who have TB at entry to ART programmes have a high mortality risk which is twofold greater than that of patients who do not have TB. The fact that immunodeficiency appears to be the key determinant of mortality in these patients suggests that in addition to antituberculosis treatment and co-trimoxazole prophylaxis they should start ART without undue delay. The key factors thought to be important in deciding the best time to start ART in TB patients are: 1) Pill burden and reduced adherence; 2) Risk of further HIV-associated morbidity; 3) Low tolerability of combined multidrug regimens; 4) Risk of HIV-associated mortality; 5) Pharmacokinetic drug interactions impairing ART outcomes; 6) Reduced risk of TB relapse; 7) Drug co-toxicity; and 8) Morbidity and mortality due to immune reconstitution disease* The new HIV/AIDS and sexually transmitted infections (STI) Strategic Plan for South Africa 2007 - 2011 offers new hope for the millions of South Africans who are living with HIV and sets important targets to improve joint management of TB and HIV. To enable our clinical services to provide better care for those with both diseases we also suggest that the South African national antiretroviral treatment guidelines for use of ART in patients with TB should be updated to recommend earlier initiation of treatment. Moreover stronger efforts should be made towards greater integration of TB and HIV treatment services. (excerpt)
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
