The British HIV Association (BHIVA) has published an interim update of its guidelines on the treatment of TB/HIV co-infection. The guidelines are designed to provide a clinical framework for the treatment of adults living with HIV in the UK who have TB.
Recommendations for the treatment of TB in HIV-positive adults are similar to those in HIV-negative adults. However, as the investigation and treatment of both TB and HIV infection is complex, it is mandatory to involve specialists in HIV, respiratory and/or infectious diseases.
The annual incidence rate of TB among adults with diagnosed HIV in England and Wales fell from 17.5 per 1000 (420/23,990) in 2008 to 4.4 per 1000 (300/68,350) in 2011. This was mainly due to a fall in the number of new HIV diagnoses among people born in sub-Saharan Africa, which has a high prevalence of both HIV and TB. An increase in the total number of people living with HIV was also a factor.
The risk of developing TB is estimated to be 26-31 times higher in people with HIV than in those without. The guidelines therefore recommend that all individuals with TB should be offered an HIV test, regardless of their perceived risk of HIV infection. Similarly, clinicians caring for people with HIV should have a high index of suspicion for TB in individuals with symptoms, especially those who have lived in regions where TB is endemic.
The previous guideline was published in 2011. The guidelines will be fully updated and revised in 2021.