CROI 2026: Tuberculosis and Other Infectious Complications in People With HIV

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Medicine

Background:

• Opportunistic infections, particularly tuberculosis (TB), remain a significant cause of mortality in people with HIV.
• Drug-resistant TB and disseminated TB in HIV-positive individuals present complex clinical challenges with high mortality rates.
• Advances in HIV management have shifted focus towards optimizing treatment and prevention of associated opportunistic infections.

Purpose of the Study:

• To summarize key findings on tuberculosis and other opportunistic infections presented at the 2026 Conference on Retroviruses and Opportunistic Infections (CROI).
• To evaluate the efficacy of intensified TB treatment and adjunctive prednisone in hospitalized HIV patients with disseminated TB.
• To assess a novel higher-dose linezolid strategy for drug-resistant TB and compare the efficacy and tolerability of two TB preventive regimens (1HP vs. 3HP).

Main Methods:

• Clinical trials evaluating intensified TB treatment and adjunctive prednisone in HIV-positive patients with disseminated TB.
• A study assessing a higher-dose linezolid regimen for drug-resistant TB.
• Two head-to-head trials comparing the efficacy and safety of 1-month daily (1HP) and 3-month weekly (3HP) isoniazid-rifapentine preventive regimens.

Main Results:

• Intensified TB treatment and adjunctive prednisone did not reduce mortality in hospitalized HIV patients with disseminated TB.
• A higher-dose linezolid strategy did not improve culture conversion rates in patients with drug-resistant TB.
• The 1HP and 3HP TB preventive regimens demonstrated comparable efficacy, but 1HP had lower treatment completion and higher intolerance.

Conclusions:

• Current intensified treatment strategies for disseminated TB in people with HIV are ineffective in reducing mortality.
• Novel dosing strategies for linezolid do not enhance treatment outcomes for drug-resistant TB.
• While 1HP and 3HP are effective TB preventive options, differences in tolerability and completion rates warrant consideration in clinical practice.