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HIV + TB Flashcards

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1
Q

What is the estimated worldwide prevalence of people with TB co-infected with HIV?

A

8%

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2
Q

What proportion of people who died with TB are co-infected with HIV?

A

1/6

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3
Q

There was a drop in TB incidence in PLW HIV in the UK between 2008-2011, what was the change in incidence?

A

17.5/1000
to
4.4/1000

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4
Q

Why was there an apparent reduction in incidence of TB + HIV co-infection between 2008-2011?

A

reduced HIV diagnosis in people from sub-Saharan Africa

increased total number of people living with HIV

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5
Q

What is the current proportion of people with TB with HIV co-infection?

A

3%

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6
Q

What is the impact of HIV on risk of developing TB?

A

risk of TB 26-31 times greater

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7
Q

Is HIV testing mandatory in TB infection?

A

YES

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8
Q

What impact does HIV have on the investigation findings for TB?

A

ATYPICAL
NORMAL CXR
Sputum SMEAR NEGATIVE, culture positive

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9
Q

What are the FIVE aims of TB treatment (as per WHO)?

A

CURE patient and restore QoL
PREVENT DEATH from active TB or complications
prevent RELAPSE
REDUCE TRANSMISSION
prevent development and transmission of RESISTANCE

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10
Q

Molecular diagnostic tests for TB identify what?

A

early identification of MYCOBACTERIUM

genotypic DRUG SUSCEPTIBILITY

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11
Q

Which mutations confer rifampicin resistance in TB?

A

rpoB

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12
Q

What is the limitation of the Xpert MTB/RIF molecular test for TB?

A

REDUCED SENSITIVITY if smear NEGATIVE

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13
Q

How does the sensitivity of TB molecular testing differ for smear POSITIVE and smear NEGATIVE samples?

A

98% smear POSITIVE
c/w
67% smear NEGATIVE

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14
Q

In addition to molecular testing for TB what additional investigation must be done?

A

CULTURE

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15
Q

Why must culture for TB be done in addition to molecular testing?

A

to increase SENSITIVITY

to identify full DRUG-SUSCEPTIBILITY

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16
Q

What is the sensitivity and specificity of IGRA in PLW HIV in active TB?

A

SUBOPTIMAL

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17
Q

What culture medium provides quicker results for TB culture?

A

LIQUID culture
c/w
solid culture

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18
Q

What is the most common presentation of CNS TB?

A

tuberculous MENINGITIS

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19
Q

What is the proportion of mortality in TB meningitis?

A

20-50%

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20
Q

What are the FOUR presentations of CNS TB?

A

MENINGITIS (most common)
ENCEPHALITIS
intracranial TUBERCULOMAS
brain ABSCESS

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21
Q

What are the non-specific symptoms of TB MENINGITIS?

A

Fever
headache
Vomiting

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22
Q

What is the timing of TB MENINGITIS?

A

gradual onset

often progressing over weeks

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23
Q

What are the TWO main investigations for TB MENINGITIS?

A

imaging MRI

Lumbar puncture

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24
Q

What is the typical finding on CSF in TB meningitis?

A

mononucleate cell pleocytosis (LYMPHOCYTIC predominant)
WCC 100-500cells/mm3
low GLUCOSE <2.5mml/L
high PROTEIN 1-5g/L

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25
What impact does HIV have on CSF of a person with TB meningitis?
ACELLULAR (ie no raised WCC)
26
What is the sensitivity of Ziehl-Neelsen staining for AFB in CNS TB?
10-60%
27
What is the sensitivity of culture from CSF of TB in CNS TB?
10-60%
28
What increases the sensitivity of CSF culture for TB?
Large volume of CSF >6mL
29
Which molecular test is recommended for diagnosing TB meningitis?
Xpert MTB/RIF ULTRA
30
What is the most common cause of lymphatic pleural effusion in PLW HIV?
TB (if HIV endemic)
31
In addition to analysis of pleural effusion what other samples are required if TB pleural effusion is likely?
PULMONARY samples for culture | sputum or BAL
32
What is the yield of sputum culture for TB in induced sputum for people with pleural effusion but no evidence of parenchymal lung disease of TB?
55%
33
What impact does CD4 cell count have on the microscopy yield of AFB in TB pleural disease?
INCREASED yield in lower CD4 count
34
What additional test of pleural fluid can help diagnose TB disease?
raised adenosine deaminase (ADA) + lymphocyte predominant exudative pleural effusion
35
What point of care test is used for diagnosis of extrapulmonary TB disease?
URINE lateral flow lipoarabinomannan (LF-LAM)
36
What impact dose CD4 cell count have on the sensitivity of point of care urine lateral flow for TB?
INCREASED
37
In addition to urine lateral flow what investigation would be useful To diagnose disseminated TB?
mycobacterial BLOOD CULTURE
38
What CYTOPATHOLOGICAL features are present in TB eg samples from lymph node, lung aspirate, focal lesions?
Macrophage GRANULOMAS +/- necrosis | AFB on ZN staining
39
What HISTOPATHOLOGICAL features are present in TB eg samples from lymph node, lung aspirate, focal lesions?
epithelioid cell GRANULOMAS +/- Langhans giant cells CASEATION NECROSIS AFB on ZN staining
40
What additional microbes should be tested for on HISTOPATHOLOGICAL suspicious for TB?
FUNGAL staining (HISTOPLASMOSIS)
41
If TB is diagnosed histopathologically but standard treatment is ineffective what must be considered?
consider NON-TB mycobacterial infection
42
What differential diagnoses can mimic TB?
``` SARCOIDOSIS HISTOPLASMOSIS NOCARDIOSIS LEISHMANIASIS GRANULOMATOUS reaction to local tumour CVID VASCULITIS AUTOIMMUED disease GRAM NEGATIVE infection (BRUCELLOSIS, MELIOIDOSIS) ```
43
What is the definition of MDR-TB?
resistance to at least ISONIAZID and RIFAMPICIN
44
What is the definition of pre-XDR-TB?
``` pre-EXTENSIVELY DRUG RESISTANT TB resistance to ISONIAZID+RIFAMPICIN and FLUOROQUINOLONE or 2nd line INJECTABLE (not both) ```
45
What is the definition of XDR-TB?
resistance to SONIAZID+RIFAMPICIN+FLUOROQUINOLONE and at least one 2nd line INJECTABLE (eg amikacin)
46
What proportion of people with TB have MDR-TB in the UK?
1.6%
47
What proportion of PLW HIV + TB have resistance to RIFAMPICIN only?
1.3%
48
What proportion of PLW HIV + TB have resistance to ISONIAZID only?
4%
49
List SIX(6) risk factors for drug-resistant TB?
1) PREVIOUS TB treatment 2) CONTACT with MDR/XDR-TB 3) birth, travel or work in settings with VERY HIGH MDR/XDR-TB 4) POOR ADHERENCE to past TB treatment 5) No clinical improvement, or smear/culture POSITIVE 3 months into treatment 6) HOMELESSNESS/HOSTEL LIVING/INCARCERATION
50
What factors increase the risk of people with latent TB developing active TB?
recent ACQUISITION of TB | IMMUNOSUPPRESSED
51
What is the incidence of TB in PLW HIV in the UK?
0.6/1000
52
What is the incidence of TB in the general UK population?
0.13/1000
53
Is the incidence of TB higher or lower in PLWHIV c/w UK general population?
HIGHER
54
What is the definition of HIGH TB incidence?
>151/100 000
55
What is the definition of MEDIUM TB incidence?
4-150/100 000
56
Over what time period is the risk of progression to active TB from latent TB highest?
2-3 years
57
What is the definition of latent TB?
positive IGRA + no clinical or radiological evidence of active TB
58
How does the NICE guideline differ from BHIVA guideline on how to diagnose latent TB?
NICE - recommends both IGRA and TST | BHIVA - recommends only IGRA
59
Why is only IGRA and not TST recommended for diagnosis of latent TB in PLW HIV?
TST reduced sensitivity in low CD4 and false positive if past BCG vaccination
60
What additional risk factors should prompt testing for latent TB, even if PLW HIV is from a country of low incidence?
``` EXPOSURE to TB TRAVEL to higher incidence countries WORKING in MEDICAL settings with high incidence TB IDU CKD Diabetes CHEMOTHERAPY IMMUNOSUPPRESSION BIOLOGICAL DISEASE MODIFIERS ```
61
If latent TB is identified in a pregnant women with HIV, should they be offered treatment in pregnancy?
YES
62
Which group of PLW HIV should be screened for TB?
People from HIGH and MEDIUM TB incidence
63
Why should latent TB be treated in PLW HIV?
PROTECTIVE effect
64
What is the first line recommended treatment for latent TB?
ISONIAZID (with PYRIDOXINE) daily | 6 months
65
What TWO alternative regimens can be used for treatment for latent TB?
``` ISONIAZID (with PYRIDOXINE) + RIFAMPICIN 3 months or ISONIAZID + RIFAMPICIN (with PYRIDOXINE) TWICE WEEKLY 3 months ```
66
What drug shows promise in SHORTER regimens for latent TB?
RIFAPENTINE
67
What RIFAPENTINE-containing regimens have been shown to be effective for latent TB?
``` ISONIAZID (900mg) + RIFAPENTINE (900mg) WEEKLY 12 weeks or ISONIAZID (300mg) + RIFAPENTINE (450-600mg) DAILY 1 month ```
68
What effect does ISONIAZID have on liver function?
Mild rise aminotransferases Not generally clinically relevant RARE symptomatic hepatotoxicity
69
What risk factors increase the risk of severe HEPATOTOXICITY with ISONIAZID?
excessive ALCOHOL OLDER age >65yrs slow ACETYLATOR LIVER DISEASE
70
What impact does ART have on the risk of TB disease?
PROTECTS against TB
71
What is the recommended first line treatment for active TB?
Rifampicin Isoniazid Pyrazinamide Ethambutol
72
Which TWO drugs are the CONTINUATION phase of TB treatment?
Rifampicin | Isoniazid
73
How long is the INTENSIVE phase and the CONTINUATION phase of TB treatment?
2 months then 4 months
74
What is the treatment duration for CNS TB?
6-12 months
75
What RIFAPENTINE-containing regimen appears to be an effective shorter regimen for active TB?
``` Pyrazinamide Rifapentine Isoniazid Moxifloxacin 8 weeks then 9 weeks DUAL ```
76
What is the benefit of RIFABUTIN for PLW HIV + TB?
can co-administer with RITONAVIR boosted PIs
77
Which group with TB + HIV should receive cortosteroids as part of TB treatment?
TB MENINGITIS | severe IRIS
78
What is the risk of giving corticosteroids to people with TB + HIV?
in non-CNS TB - increased risk of HIV-associated disease KS CMV
79
How might mycobacterium avid (MAC) be differentiated from mycobacterium tuberculous (TB)?
Smear AFB positive | Negative molecular test
80
What dose of RIFAMPICIN should be used in the INDUCTION phase for treatment of TB in people with CD4 <100?
HIGHER dose 15mg/kg vs 10mg/kg (higher CD4)
81
If the clinical picture suggests disseminated MAC, what should be added to the TB regimen whilst awaiting results?
RIFABUTIN (instead of rifampicin) | MACROLIDE (clarithromycin or azithromycin)
82
How should a TREATMENT INTERRUPTION be managed - INTENSIVE phase, LESS than 14 days since last dose?
CONTINUE | COMPLETE planned total doses
83
How should a TREATMENT INTERRUPTION be managed - INTENSIVE phase, GREATER than 14 days since last dose?
RESTART treatment
84
How should a TREATMENT INTERRUPTION be managed - CONTINUATION phase, >80% doses + SMEAR NEGATIVE in pulmonary disease?
TREATMENT can stop
85
How should a TREATMENT INTERRUPTION be managed - CONTINUATION phase, >80% doses + SMEAR POSITIVE or EXTRAPULMONARY disease?
CONTINUE ALL DOSES
86
How should a TREATMENT INTERRUPTION be managed - CONTINUATION phase, <80% doses + cumulative lapse <3 months, consecutive lapse <2 months?
CONTINUE ALL DOSES
87
How should a TREATMENT INTERRUPTION be managed - CONTINUATION phase, <80% doses + cumulative lapse >3 months?
RESTART treatment (include INTENSIVE)
88
Within what time frame must ALL doses in the INTENSIVE phase of TB treatment be complete?
3 months
89
Within what time frame must ALL doses in the CONTINUATION phase of TB treatment be complete?
6 months
90
What tests of vision are required before TB treatment?
``` VISUAL ACUITY (Snellen chart) COLOUR vision (Ishihara plate) ```
91
Why does visual ACUITY and COLOUR vision need to be checked before TB treatment?
ETHAMBUTOL can affect both
92
Why should hepatitis B & C be checked prior to TB treatment for PLW HIV?
PLW HIV have higher risk of viral hepatitis | TB treatment can cause hepatotoxicity
93
For patients with liver disease how often should they be monitored after starting TB treatment?
2 weekly
94
What is the definition of treatment FAILURE in TB?
smear or culture POSITIVE 5 months into treatment
95
What is the definition of RELAPSE in TB treatment?
previous treatment for TB completed | New episode of TB
96
What is the definition of TREATMENT AFTER FAILURE in TB treatment?
previous treatment for TB whose treatment failed at the end of most recent course
97
What proportion of people with PULMONARY TB treated with multi drug therapy will be culture/smear NEGATIVE at 3 months?
98%
98
What is the main reason for TB treatment failure?
poor adherence
99
What impact does ART have on TB developing drug resistance?
reduces acquired RIFAMYCIN resistance
100
What should be tested for in TB treatment failure or relapse?
Drug susceptibility
101
Whilst awaiting drug susceptibility results what NEW regimen could be considered for relapsed or treatment failure in TB?
``` RIFAMPICIN + FLUROQUINOLONE + CLOFAZIMINE or LINEZOLID ```
102
What proportion of PLW HIV + TB have ISOLATED isoniazid resistance?
6%
103
What TB regimen should be given to people with isolated isoniazid resistance?
Rifampicin Levofloxacin Pyrazinamide Ethambutol
104
What class of drugs is substituted for isoniazid in isoniazid resistant TB?
FLUROQUINOLONES
105
Which parts of the world have a high risk for MDR-TB?
RUSSIA | EASTERN EUROPE
106
How is treatment for MDR-TB given?
ALL-ORAL shorter regimen
107
What is the all-oral shorter regimen for MDR-TB?
``` BEDAQUILINE LEVOFLOXACIN ETHIONAMIDE CLOFAZIME ISONIAZID PYRAZINAMIDE ETHAMBUTOL ```
108
Is surgical management useful for TB treatment?
selected cases of PULMONARY MDR-TB
109
BEDAQUILINE is used as part of a regimen to treat what TB?
rifampicin resistant (RR)/MDR-TB
110
What is the action of bedaquiline?
INHIBITS mycobacterial ATP synthase
111
What effect can bedaquiline have on QTc?
PROLONGATION
112
Which other TB antimicrobials may cause QTc prolongation other than bedaquiline?
QUINOLONES | CLOFAZIME
113
What is the action of DELAMANID?
inhibits MTB CELL WALL synthesis
114
What properties of PRETOMANID make it a potential part of TB treatment in the future?
activity on actively REPLICATING and SLOWLY dividing mycobacteria
115
What has PRETOMANID been combined with for treatment of XDR-TB?
BEDAQUILINE | LINEZOLID
116
Which patient groups may benefit from direct observed therapy (DOT) for TB?
``` MIGRANTS PRISONERS users of DRUGS HOMELESS MENTAL ILLNESS ```
117
When should ART be started within 2 weeks in PLW HIV and TB?
CD4 <50 cells
118
Other than at low CD4 count when should ART be started in context of HIV and TB?
after INDUCTION phase | unless patient keen to start sooner
119
What is the preferred ART of choice for HIV + TB co-infection?
TDF/FTC + EFAVIRENZ
120
What dosing adjustment should be made to RALTEGRAVIR is used as ART in HIV + TB co-infection?
TWICE daily dosing DOUBLE dose 800mg BD
121
What dosing adjustment should be made to DOLUTEGRAVIR is used as ART in HIV + TB co-infection?
TWICE daily dosing | 50mg BD
122
In what RARE circumstances might ART interruption be required for a person on established ART and starting TB treatment?
Failing ART due to poor ADHERENCE | may be best to stop ART whilst established on TB treatment
123
Is there any dosing adjustment required for efavirenz when used alongside rifampicin?
NO (traditionally there was) STANDARD dose 600mg DAILY unless high BMI
124
Can NEVIRAPINE be used alongside RIFAMPICIN?
Yes - If patient STABLE on nevirapine | do not start nevirapine
125
What effect does RIFAMYCINS have on metabolism of CORTICOSTEROIDS?
ACCELERATED | need to increase dose of steroid
126
What effect does RIFAMPICIN have on metabolism of METHADONE?
INCREASED elimination | risk of symtomatic WITHDRAWAL
127
If a PLW HIV is co-infected with TB and hepatitis C how should this be managed?
Treat TB FIRST | then hepatitis C
128
When might therapeutic drug monitoring be considered in the treatment of both HIV and TB?
ADHERENCE concerns VIRAEMIA RIFABUTIN 150mg 3x/week + COBICISTAT
129
In addition to poor adherence what else should be considered if HIV viraemia or poor response to TB treatment?
MALABSORPTION
130
What increases risk of MALABSORPTION for PLW HIV?
low CD4 count | HIV ENTEROPATHY or other HIV-related GI disease
131
What common side effects may occur as a result of either ART or TB treatment?
FEVER RASH HEPATOTOXICITY
132
What is the definition of drug-induced liver injury (DILI)?
AST or ALT >3x ULN + SYMPTOMS or AST or ALT >5 ULN, NO symptoms
133
What is the ACUTE management of drug-induced liver injury in PLW HIV and on TB treatment?
1) STOP hepatotoxic medication eg isoniazid, rifampicin, pyraxinamide, co-trimoxazole 2) VIRAL HEPATITIS serology 3) Other HEPATOTOXINS eg alcohol
134
When can TB medication be re-introduced following cessation for drug-induced liver injury?
AST/ALT < 2x ULN
135
Rank these anti-TB drugs in order of risk of HEPATOTOXICITY in context of pre-existing liver disease - rifampicin, isoniazid, pyrazinamide?
PYRAZINAMIDE> ISONIAZID> RIFAMPICIN
136
How should LFTs be interpreted if deranged due to pre-exisiting liver disease prior to TB treatment?
pre-treatment LFT is 'BASELINE' | threshold 2-3x upper limit of 'baseline'
137
What symptoms should patients be aware of that suggest liver injury in TB treatment?
``` ANOREXIA NAUSEA VOMITING ABDOMINAL PAIN JAUNDICE ```
138
What common GI side effects are experienced with TB treatment?
EPIGASTRIC pain NAUSEA VOMITING
139
What recommendations can be made to support people on anti-TB treatment manage GI side effects?
Take meds with MEALS change dose TIMING SWITCH regimen
140
Why is PYRIDOXINE use alongside ISONIAZID?
To reduce PERIPHERAL NEUROPATHY
141
If PERIPHERAL NEUROPATHY is experienced with ISONIAZID what can be done?
increase PYRIDOXINE
142
What dose adjustment of PYRIDOXINE can be made if PERIPHERAL NEUROPATHY develops with ISONIAZID?
INCREASE to 50mg DAILY (from 10mg)
143
Which anti-TB treatment most commonly causes a RASH?
ETHAMBUTOL
144
If drug-induced liver injury or rash occurs after re-introduction of ALL anti-TB drugs how should this be managed?
re-introduce SEQUENTIALLY | ETHAMBUTOL then ISONIAZID then RIFAMPICIN
145
What is it called when a person gets an exacerbation of symptoms after starting antiTB treatment?
PARADOXICAL reaction | Immune reconstitution disease or inflammatory syndrome (IRIS)
146
What is the presumed pathophysiology of IRIS in people with ART and TB treatment?
abnormal immune response to tubercle ANTIGENS released by dead or dying BACILLI
147
What are the TWO manifestations of IRIS in HIV?
PARADOXICAL - worsening of symptoms of known disease | UNMASKING - occult opportunistic infection becomes apparent after ART started
148
What other factors need to be excluded before diagnosing IRIS during TB treatment?
TB treatment FAILURE Drug HYPERSENSITIVITY OI MALIGNANCY
149
What proportion of patients started on ART and TB treatment develop IRIS?
15.7%
150
What TWO presentations are most common in TB-IRIS?
FEVER | LYMPHADENOPATHY
151
What is the clinical presentation of TB-IRIS, other than fever or lymphadenopathy?
``` PULMONARY lesions PLEURAL or PERICARDIAL lesions ASCITES PSOAS abscess CUTANEOUS lesions TUBERCULOMAS Granulomatous HEPATITIS ```
152
What dose of corticosteroid should be used in TB-IRIS?
1-1.5mg/kg for 1-2 weeks then reduce
153
What happens to corticosteroid metabolism if administered with rifampicin?
INCREASED | reduced effect
154
What viral infections can be induced by high dose corticosteroid?
CMV retinitis | Kaposi sarcoma
155
What potential impact does corticosteroid have on TB-IRIS if started with ART?
reduced IRIS reduced need for STEROID well TOLERATED
156
Should corticosteroid be given to prevent TB-IRIS?
No (not currently recommended)
157
What is the potential complication if TB lymph node or abscess spontaneously ruptures?
SINUS formation | SCARRING
158
What can be done to manage swollen, tense lymph nodes or abscesses due to TB?
recurrent needle ASPIRATION
159
Through what mechanism might MONTELUKAST be useful in TB-IRIS?
Leukotriene activity implicated in IRIS
160
What other therapies may be useful for TB-IRIS other than steroid or montelukast?
``` THALIDOMIDE/LENALIDOMIDE TOCILIZUMAB Interleukin-2 INFLIXIMAB HYDROXYCHLOROQUINE ```
161
When should women who are pregnant and have TB infection be treated?
As soon as possible if ACTIVE TB | In pregnancy
162
What is the treatment regimen for TB treatment in women who are pregnant?
STANDARD first line treatment | RIPE
163
What impact does PREGNANCY have on the risk of developing peripheral NEUROPATHY with ISONIAZID?
INCREASED risk
164
Which alternative TB antimicrobials are CONTRAINDICATED in PREGNANCY?
``` STREPTOMYCIN AMIKACIN KANAMYCIN PROTHIONAMIDE ETHIONAMIDE ```
165
Which alternative TB antimicrobials can cause CONGENITAL DEAFNESS in PREGNANCY?
STREPTOMYCIN AMIKACIN KANAMYCIN
166
Which alternative TB antimicrobial is TERATOGENIC?
PROTHIONAMIDE
167
Which new TB treatment could be considered but has limited data on use in pregnancy?
BEDAQUILINE
168
When should a women with HIV be tested for latent TB?
same guidance as for non-pregnant PLW HIV
169
What risk is there to the women if active TB is not treated during pregnancy?
HAEMATOGENOUS spread via PLACENTA and DISSEMINATED TB
170
What factor should be considered when deciding when to treat LATENT TB in a woman who is PREGNANT?
RECENT ACQUISITION - requires treatment in pregnancy
171
In LATENT TB, if a pregnant woman has recently acquired it what impact does it have on timing of treatment?
RECENT - treat in pregnancy to reduce risk of haematogenous spread HISTORICAL - otherwise delay until after pregnancy
172
For babies born to mothers treat for TB in pregnancy what impact does it have on birth outcomes?
LOW BIRTH WEIGHT
173
What is the recommendation for women of childbearing age who are undergoing treatment for TB?
use CONTRACEPTION | especially if MDR-TB
174
What impact does TB treatment have on BREASTFEEDING?
NO impact | Possible low dose antibiotic in breast milk
175
When should a person who is being treated for PULMONARY TB be admitted to hospital?
only if CLINICAL or PUBLIC HEALTH need
176
If a person is admitted to hospital with PULMONARY TB, what type of room should the be nursed in?
NEGATIVE pressure room
177
How should close contacts of people with pulmonary or laryngeal TB be managed?
SCREEN for TB
178
What is an alternative management of people in close contact with MDR-TB other than preventive treatment?
OBSERVE and MONITOR for development of ACTIVE TB
179
Is TB a notifiable disease?
YES
180
What are the potential causes of DEATH in TB/HIV co-infection?
Active PROGRESSIVE TB SECONDARY effects of TB ie lung haemorrhage IRIS affecting critical ORGANS AntiTB DRUG TOXICITY HIV or non-HIV related COMORBIDITY Othe FATAL disease not related to TB or HIV
181
What are the potential clinical presentations or syndromes that lead to DEATH from ACTIVE progressive TB?
CRITICAL ORGAN FAILURE | SYSTEMIC SEPTIC SHOCK
182
What are the potential clinical presentations or syndromes that lead to DEATH that are secondary effects of TB?
Lung HAEMORRHAGE MENINGOVASCULAR obstruction STROKE
183
If person with TB dies what samples should routinely be sent from autopsy and why?
TUBERCULOUS TISSUE | for CULTURE and DRUG SENSITIVITY
184
What impact does HIV have on molecular testing sensitivity for TB?
REDUCED SENSITIVITY | 79% PLW HIV vs 86% no HIV
185
What is the potential utility of lateral flow urine LAM assay in diagnosing TB?
``` in people DIFFICULTY producing SPUTUM or EXTRAPULMONARY TB or DISSEMINATED TB ```
186
What is the LIMITATION of lateral flow urine LAM assay in diagnosing TB?
less SENSITIVE | CROSS-REACTIVITY = FALSE POSITIVES
187
What does an IGRA measure?
Interferon-Gamma Release from Cells after STIMULATION with ANTIGENS specific to MTB
188
What is the MAJOR criteria for diagnosing TB - PARADOXICAL IRIS?
``` 1) New, enlarging or abscess LYMPH NODES New or worsening 2) RADIOLOGY 3) CNS TB signs 4) SEROSITIS (pleural, pericardial, ascites, arthritis) ```
189
What is the MINOR criteria for diagnosing TB - PARADOXICAL IRIS?
new or worsening 1) CONSTITUTIONAL symptoms 2) RESPIRATORY symptoms 3) ABDOMINAL pain 4) in RETROSPECT, RESOLVING symptoms without changing TB therapy
190
What combination of MAJOR and MINOR criteria must be met to make a diagnosis on TB - PARADOXICAL IRIS?
ONE major or TWO minor
191
What is the MAJOR criteria for diagnosing TB - UNMASKING IRIS?
NO treatment when ART is started and ACTIVE TB within 3 months of ART start
192
What is the MINOR criteria for diagnosing TB - UNMASKING IRIS?
1) heightened INTENSITY of clinical MANIFESTATIONS with evidence of marked INFLAMMATORY component 2) PARADOXICAL reaction once on TB treatment
193
What combination of MAJOR and MINOR criteria must be met to make a diagnosis on TB - UNMASKING IRIS?
ONE major + ONE minor
194
Within what timeframe does the majority of IRIS occur after starting ART?
60 days
195
What is the MEDIAN timeframe for IRIS after starting ART?
15 days
196
DDIs - AMINOGLYCOSIDES and ART-what monitoring?
RENAL
197
DDIs - FLUROQUINOLONES and ART-what monitoring?
QTC
198
Which antiTB agent is an essential component of SHORT course (6 month) TB treatment?
PYRAZINAMIDE | extend TB treatment to 9 months if cannot give
199
If PYRAZINAMIDE cannot be given as part of SHORT course (6 month) TB treatment how should the regimen be altered?
extend TB treatment to 9 months if cannot give
200
What factor predicts increased relapse after completion of TB treatment?
SMEAR positive at end of treament
201
If smear POSITIVE at end of TB treatment what should be done?
check ADHERENCE | EXTEND TB treatment to 9 months

DipHIV (14 decks)

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