HIV: treating tuberculosis

In people infected with both HIV and Mycobacterium tuberculosis, the annual risk of developing active tuberculosis is 5% to 10% - more than 10 times the rate for HIV-negative people with M tuberculosis infection. Untreated, mortality from tuberculosis in people with HIV is likely to be high, and over 5% of people relapse after successful treatment.

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of first-line treatments for tuberculosis in HIV-positive people? What are the effects of second-line treatments for tuberculosis in HIV-positive people? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant immunotherapy (with corticosteroids, or Mycobacterium vaccae); antimycobacterial treatment combinations; conventional antituberculous treatment (short course, long course, including rifabutin [3 or 5 months], quinolones, or thiacetazone); directly observed therapy (short course); highly active antiretroviral treatment (early initiation or delayed initiation); rifampicin (3 months or less); secondary prophylaxis with antituberculous treatment; and unsupervised treatment.