TB

Question 1

LTBI screening HIV

Answer 1

Screen all PLWHIV from high risk countries

IGRA preferred

Repeat in 4 weeks if first IGRA inconclusive

6 months of isoniazid plus pyridoxine; or 3 months of isoniazid plus rifampicin plus pyridoxine

Question 2

Rifampicin in TB/HIV

Answer 2

Replace with rifabutin when on PI/r

Question 3

When to start ART in TB/HIV

Answer 3

ASAP within 4 weeks

<2 weeks if CD4 < 50

8 weeks later in CNS TB (start late!)

Question 4

ART choice & Caveats in TB

Answer 4

efavirenz (standard dose) in combination with TDF and emtricitabine as first-line ART for people taking rifampicin-based TB treatment.

Raltegravir or dolutegravir may be used as alternatives to efavirenz.

Rifabutin in ritonavir-boosted PIs.

We recommend against the use of cobicistat with rifampicin or rifabutin.

We recommend against the use of fixed-dose combinations containing TAF or bictegravir, and dual therapy with cabotegravir/rilpivirine or dolutegravir/lamivudine until supporting clinical outcome data become available.

Question 5

Preferred ARV in TB

Answer 5

Dol preferred 50mg BD

INSIGHT trial - emerging evidence that BIC/TAF levels unaffected by ATT