Updates to the Tuberculosis Section of the Adult and Adolescent Opportunistic Infections Guidelines

Updates to the Tuberculosis Section of the Adult and Adolescent Opportunistic Infections Guidelines

The Mycobacterium tuberculosis Infection and Disease section of the Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV has been updated. The Panel updated this section to reflect the availability of results from a number of new studies in tuberculosis (TB) diagnostics, therapeutics, pharmacology, and drug resistance. Several key highlights include:

• The 3HP regimen (weekly isoniazid plus rifapentine for 3 months) for the treatment of latent tuberculosis infection (LTBI) is now recommended as an alternative regimen when provided as self-administered therapy or directly observed therapy.
• Four months of daily rifampin monotherapy is now recommended for the treatment of LTBI in patients who cannot receive isoniazid.
• When dolutegravir is given with concurrent rifampin, it is recommended that the dose be increased to 50 mg twice daily.
• Bictegravir is not recommended to be given with rifamycin-containing TB treatment.
• Isoniazid preventive therapy is not recommended for pregnant women until after delivery unless they are close contacts of a known patient with active TB disease.
• Prednisone is no longer recommended for the treatment of TB pericarditis.
• Isoniazid-monoresistant TB should be treated with 6 months of rifampin, pyrazinamide, ethambutol, and either levofloxacin or moxifloxacin.
• For patients at high risk for developing TB-associated immune reconstitution inflammatory syndrome (TB-IRIS), pre-emptive prednisone is recommended as adjunctive therapy with the initiation of antiretroviral therapy.