Question

According to the World Health Organization (WHO) guidelines, patients with TB-HIV co-infection should receive the same TB drug regimen as those patients without co-infection. Do you agree with this protocol? Why or why not? Support your answer using findings from 1) basic research articles you find

Answer 1

The interaction between Tuberculosis (TB) and Human Immunodeficiency Virus. (HIV) infection is of prime importance because the two occur commonly together in different parts of the world. One infection makes the other worse and together they create one might refer to as a ‘perfect storm’. Among the overall TB patients, approximately 13% is co-infected with HIV. That means a large part of the population is affected with this and which this is a problem. It actually represents over a 1million people. Among the deaths due to TB, one in three of these individuals is co-infected with HIV. Both the infections are bad, hence clearly, ultimately both the treatments have to treated. Form TB, anti-tuberculosis drugs are used and for HIV, antiretrovirals has to be used in order to control the infection. The treatment is associate with the adverse effects in something known as the ‘immune reconstitution inflammatory syndrome (IRIS). Antiretroviral treatment for the HIV infection, the latent TB infection becomes clinically manifest. The treatment of HIV with antiretrovirals reconstitute the immune system and makes TB infection become evident. Having both TB and HIV at the same time, the drugs used to treat each infection might adversely interact with each other. One of the most important interaction is the effect of rifampin, a key drug for treating TB on the antiretroviral agents. Rifampin is known to be an inducer of an important enzyme system in liver called the cytochrome P450 enzymes that are responsible for metabolising a lot of drugs. antiretroviral agents are also induced by cytochrome P450 enzymes, hence when the rifampin and antiretroviral agents are used together, rifampin induces cytochrome P450 enzymes causing the antiretrovirals to be metabolised quickly and lose their effectiveness more quickly. Hence the interactions should be understood in a better way so that the treatment of infections needs to be modified or modulated accordingly. Hence the same series of drugs used for treating TB without HIV coinfection need to be studied for the drug interactions before treating the coinfected patients.