5
Treatment in Special Situations
➤ Recommendation 5a: For HIV-infected patients receiving ART, the
panel suggests using the standard 6-month daily regimen consisting
of an intensive phase of 2 months of INH, RIF, PZA, and EMB followed
by a continuation phase of 4 months of INH and RIF for the treatment
of drug-susceptible pulmonary tuberculosis (C-VL).
➤ Recommendation 5b: In uncommon situations in which HIV-infected
patients do NOT receive ART during tuberculosis treatment, the panel
suggests extending the continuation phase with INH and RIF for an
additional 3 months (ie, a continuation phase of 7 months in duration,
corresponding to a total of 9 months of therapy) for treatment of drug
susceptible pulmonary tuberculosis (C-VL).
➤ Recommendation 6: The panel recommends initiating ART during
tuberculosis treatment. ART should ideally be initiated by 8–12 weeks
of tuberculosis treatment initiation for patients with CD4 counts ≥50
cells/μL. ART should ideally be initiated within the first 2 weeks of
tuberculosis treatment for patients with CD4 counts <50* cells/μL
(S-H).
*An exception is patients with HIV infection and tuberculous meningitis
(see Immune Reconstitution Inflammatory Syndrome in the full text Guidelines).
Extrapulmonary Tuberculosis
➤ Recommendation 7: The panel suggests initial adjunctive
corticosteroid therapy NOT be routinely used in patients with
tuberculous pericarditis (C-VL)
➤ Recommendation 8: The panel recommends initial adjunctive
corticosteroid therapy with dexamethasone or prednisolone tapered
over 6–8 weeks for patients with tuberculous meningitis (S-M).
Culture-Negative Pulmonary Tuberculosis in Adults
➤ Recommendation 9: The panel suggests that a 4-month treatment
regimen is adequate for treatment of HIV-uninfected adult patients
with AFB smear- and culture-negative pulmonary tuberculosis (C-VL).
S, strong ; W, weak strength of recommendation
H, high; M, moderate; L, low; VL, very low quality of evidence
