Evidence for treatment policy for HIV-infected tuberculosis patients : annual report 2009

Overview

This business line aims to produce the evidence needed to drive the development and delivery of TB/HIV care guidelines in disease-endemic settings.

Despite improved availability of TB drugs through the WHO Global Drugs Facility (GDF) and the universal scale-up of antiretroviral (ARV) medicines, developing countries are confronted by a soaring disease burden of HIV-driven TB. Further, there is limited evidence on case management strategies – factors which challenge resource-limited health systems to cope effectively.

The global challenge inherent in both the burden of TB driven by HIV/AIDS and a dearth of resources to optimize control is that new lines of evidence that would improve control are in urgent demand. It is in this context that the activities being undertaken by this BL since its inception in 2007 have increased in importance and urgency.

According to WHO, 79% of HIV-infected TB patients live in sub-Saharan Africa, and the annual trend in TB incidence almost parallels HIV prevalence in some countries. This concomitant occurrence of TB with HIV provides an acute need to define optimal timing of ARV therapy during TB treatment and to find alternatives to current drug regimens (particularly those with rifampicin) to minimize side-effects from drug interactions. Independent of HIV status, the long duration of TB treatment is an obstacle to effective TB control. Fluoroquinolone-containing regimens may allow for simpler, shorter regimens; however, these must be evaluated in clinical trials that investigate efficacy as well as safety so as not to sacrifice appropriate treatment outcomes for a shortened duration of treatment. In spite of widespread deployment of fixed-dose combination anti-TB chemotherapy, their safety and comparable efficacy has not been appropriately evaluated, Overview and highlights especially in the targeted mixed populations of HIV-infected and -uninfected TB patients. There is also a need for bioavailability studies to ensure that serum drug concentrations of these fixeddose combinations are not being compromised by “fixing” and by altered absorption resulting from concomitant HIV disease.