The past decade has delivered key developments in diagnostics for tuberculosis (TB), particularly for coinfected patients. Nucleic acid amplification tests such as Xpert and Xpert Ultra can provide a result within two hours of lab processing, and can also test for rifampicin susceptibility. Another breakthrough is the Urine LAM test, a point-of-care, non-sputum-based test which performs well in HIV-infected patients with CD4
More recently, a novel LAM assay developed by Fujifilm was used to test >900 urine samples of HIV-infected hospitalised patients, revealing increased sensitivity from 42% to 70% when compared with the existing Alere-LAM, and in patients with CD4
In the last five years, two novel classes of TB drugs have reached licensing and the interim results of the single arm NiX-TB trial showed that in patients with XDR-TB, 88% were cured after a 6-month regimen of 3 drugs.
Providing ART early reduces mortality in HIV-associated TB across all patients. In patients with CD450, there is no mortality benefit. Therefore, WHO recommends starting ART within eight weeks in all TB patients, and within two weeks for patients with CD4
DDIs with rifampicin are known and TAF is the only non-nucleoside reverse transcriptase inhibitor (NNRTI) with significant interactions. Although coadministration of TAF and rifampicin is not advised, this interaction is being further explored.
“I think that the advice with respect to same-day ART is very much to screen for TB symptoms. If there are TB symptoms present, same-day ART should not be given, but testing for TB should be done. With that approach I think you will minimise the risk of causing unmasking TB-IRIS.”