Physicians have several options for the treatment of latent tuberculosis among patients with HIV, all of which have benefits and drawbacks, according to James C. Brust, MD, of Albert Einstein College of Medicine and Montefiore Medical Group, both in the Bronx, NY.
The most well-known regimen is daily isoniazid given with pyridoxine for 9 months. Daily rifampin or rifabutin for 4 months is a “significantly shorter” regimen, but there is a “strong potential” for drug-drug interactions between these agents and ART, Brust said.
Twelve weeks of weekly isoniazid and rifapentine given together is a novel regimen that holds “tremendous promise,” Brust said, but one “very important caveat” relates to concerns about drug-drug interactions with ART. This is being addressed in ongoing research.
Drug resistance should also be considered when choosing a regimen for patients with HIV and latent TB, according to Brust. Currently, the best strategy for patients who come from areas with a high endemicity of drug-resistant TB or who have had contact with another patient with drug-resistant TB is “a largely unanswered question.”