HIV/TB. Sylvia LaCourse MD, MPH Department of Medicine, Division of Allergy & Infectious Disease. TB Clinical Intensive Seattle, WA June 16-17, 2016
|
|
- Barnard Short
- 6 years ago
- Views:
Transcription
1 HIV/TB Sylvia LaCourse MD, MPH Department of Medicine, Division of Allergy & Infectious Disease TB Clinical Intensive Seattle, WA June 16-17, 2016
2 Roadmap for today s talk HIV/TB Epidemiology Global US HIV LTBI->TB Latent TB infection (LTBI) Active TB disease (TB) TB Screening/diagnosis Treatment ART/TB medication interactions IRIS LTBI Diagnosis IGRA, TST Treatment
3 Background 9.6 new cases of TB in 2014 Died From TB 1.2 million were HIV+ 400,000 were HIV+ 1/4 global deaths among HIV+ due to TB TB is the leading cause of death among HIV+ globally WHO 2015
4 Global TB Epidemiology WHO 2015
5 Global TB/HIV Epidemiology TB and HIV are co-epidemics WHO 2015
6 Global TB/HIV epidemiology: over time WHO 2015
7 US TB Epidemiology Reported TB Cases United States, ,000 No. of Cases 25,000 20,000 15,000 10,000 5,000 0 HIV epidemic contributed to TB resurgence in late 80s Year CDC 2014
8 70 US TB/HIV Epidemiology Estimated HIV Coinfection in Persons with TB, % Coinfection Proportion of TB cases with HIV decreasing 0 All Ages Aged CDC 2015
9 US TB/HIV Epidemiology: global = local Estimated HIV/TB Coinfection US vs Foreign Born Proportion of TB cases with HIV decreasing except among foreign born Albarak, Arch Intern Med 2007
10 Question 1 Which of the following is false? A. Globally, TB incidence is declining B. In the US, TB incidence is declining C. Globally, incidence of TB among HIV+ is declining D. In the US, proportion of new TB cases with HIV is declining E. In the US, proportion of new TB cases with HIV who are foreign born is declining
11 Latent TB (LTBI) and active TB HIV- 10% over lifetime greatest risk in 1st 2 years HIV+ 10% per year Small, NEJM 2001
12 HIV kills TB-specific CD4 cells Impairs macrophage activation Fewer lung-homing CD4 cells Defective granuloma formation Loss of control of infection Geldmacher, Curr Opin HIV AIDS, 2012
13 MTb infection TB disease Although ART significantly decrease risk of TB in HIV+, risk is still much higher than among HIV- Lawn, Clin Dev Immunology 2011
14 Clinical Manifestations of TB in HIV+ Clinical presentation influenced by degree of immunosuppression However, risk of TB still higher among well controlled HIV+ w/ CD4>500 vs. HIV- Most still present with pulmonary disease Upper lobe fibronodular infiltrates +/- cavitation Advanced HIV (CD4 < 200) Can have pulmonary TB (+ AFB/cx) w/ nml CXR Smear often negative->paucibacillary Extrapulmonary/disseminated disease more common (20%-50%) Lymphadenitis, pleuritic, pericarditis, meningitis, sepsis DHHS 2015
15 Of 72 EPTB pts 35 (49%) abnml CXR Of 57 w/ sputum collected 5 Sm+, 12 Cx+ No significant difference of Cx+ between patients with abnml vs. nml CXR 7/30 (23%) vs 5/27 (19%), p = /5 (40%) HIV+ had nml CXR, but Cx+ Parimon, CHEST 2008
16 Of 72 EPTB pts 35 (49%) abnml CXR Of 57 w/ sputum collected 5 Sm+, 12 Cx+ Abn CXR common w/ EPTB Nml CXR does not rule out pulm involvement in EPTB No significant difference of Cx+ between patients with abnml vs. nml CXR 7/30 (23%) vs 5/27 (19%), p = /5 (40%) HIV+ had nml CXR, but Cx+ Parimon, CHEST 2008
17 Question 2a Which of the following is false? A. HIV significantly increases the risk of progression from LTBI to TB B. ART significantly decreases the risk of TB among HIV+ C. Once on ART, risk of TB among HIV+ is similar to HIV- D. Most common presentation of TB among HIV+ is extrapulmonary E. A & C F. C & D
18 Question 2b 25 y/o woman from Eritrea, HIV+ not yet on ART with CD4 100 presents with 2-3 month history of enlarging cervical lymph node, fever and weight loss. She denies obvious cough. You are concerned for extrapulmonary TB. Which of the following should be part of the workup for extrapulmonary TB in this HIV+ patient? A. Lymph node biopsy including AFB smear and culture B. CXR C. Sputum AFB smear and culture D. All of the above E. A & B
19 Challenges in TB treatment in HIV+ Adherence polypharmacy Side effects overlapping side effects of anti-tb and ART Immune reconstitution inflammatory syndrome (IRIS) Drug-drug interactions What to start, and when to start?
20 TB treatment in HIV+ Anti-TB regimen generally the same for non-hiv Initial phase: INH, RIF, PZA, EMB x 2 months Continuation phase: INH, RIF x 4 months Extended to 7 months if initial CXR + cavitation & Cx + at end of 2 months of initial phase. Initial phase caveats w/ HIV+: INH, RIF, PZA, EMB should be given daily Continuation phase caveats w/ HIV+: INH/RIF once weekly contraindicated INH/RIF twice weekly not recommended w/ CD4<100 (given 3 times weekly INH/RPT not recommended ATS, CDC, IDSA, MMRW 2003 DHHS 2015
21 Drug(s) Duration Interval Comment Initial phase INH, RIF, PZA, EMB Continuation phase TB treatment in HIV+ 2 months Daily Recommended INH/RIF 4 months Daily Recommended INH/RIF 4 months 3 x week Alternative (BII) INH/RIF 4 months Twice weekly Not recommended for HIV+ with CD4 <100 INH/RPT 4 months Once weekly Contraindicated ATS, CDC, IDSA, MMRW 2003 DHHS 2015
22 TB treatment in HIV+ (cont.) Culture-negative pulmonary TB 6 months total treatment (vs. 4 months HIV-) Extra-pulmonary (same as HIV-) 6-9 months Meningitis (same as HIV-) 9-12 months Adjunctive corticosteroids CNS, pericardium involvement ATS, CDC, IDSA, MMRW 2003 DHHS 2015
23 Basic Principles in ART and TB treatment Rifamycin-based TB treatment is cornerstone of effective TB treatment Efavirenz-based ART preferred Most drug-drug interactions for anti-tb tx and ART are due to Rifampin Rifampin potent inducer of P450 enzyme 3A sometimes requires ART dose adjustment (typically dose) Rifabutin less potent inducer If take with other drugs that induce or inhibit CYP3A, can effect rifabutin concentration Sometimes requires rifabutin dose adjustment (can be or dose) Important: if ART dc d, rifabutin likely subtherapeutic CDC 2013
24 Why start ART? ART associated with decreased mortality in HIV+ TB patients Primarily w/ CD4 < 50 Study Patients ARV timing Outcome Blanc (Cambodia) N = 661 Median CD4 = 25 2 Vs 8 weeks HR for death 0.62 (for early ARVs) Havlir (Africa, Asia, NA, SA) N = 809 Median CD4 = 77 Median of 10 Vs 70 days Death rate: Overall 12.9% Vs 16.1% (NS) CD4 < 50: 15.5% Vs 26.6% (P=0.02) Karim (S. Africa) N = 642 Median CD4 = 150 Median of 21 Vs 97 days AIDS or Death: Overall: No difference CD4 < 50: 8.5 Vs 26.3 per 100 py (P=0.06) ART associated with decreased risk of TB among HIV START trial early ART vs. deferred risk of TB (0.09 vs. 0.28, HR 0.29 [ ] p =0.008) Blanc, NEJM, 2011 Havlir, NEJM 2011 Karim, NEJM 2011 START, NEJM, 2015
25 Timing of ART and TB treatment ART is recommended for all HIV+ with TB For ART-naïve CD4 < 50 start ART within 2 weeks CD4 > 50 start by 8-12 weeks Caution with early ART and meningitis, though still recommended If already on ART, continue May require medication adjustment DHHS 2015
26 ARV ARV dose change RIF dose change Comments NNRTIs Efavirenz ART and RIF recommended dose adjustments None; some 800mg if >50kg No change Preferred Regimen Nevirapine Rilpivirine Etravirine Protease inhibitors Atazanavir (single agent or ritonavir boosted) Darunavir/r Fosamprenavir/r Saquinavir/r Lopinavir/ritonavir (Kaletra ) Super-boosted lopinavir/ritonavir (Kaletra ) lead-in dose 200 mg twice daily, continue as maintenance dose Contraindicated Contraindicated No change Lopinavir 800 mg plus No change ritonavir 200 mg twice daily (double dose) Lopinavir 400 mg plus No change ritonavir 400 mg twice daily (super boosting) Avoid lead-in 200mg once daily, assoc w/ virologic failure Consider therapeutic drug monitoring. Significant decrease in Rilpivirine Significant decrease in PIs, Increased PI doses associated +/- hepatotoxicity Hepatotoxicity in healthy volunteers Better-tolerated among HIV+ already on LPV/r Hepatotoxicity in healthy volunteers CDC 2013
27 ART and RIF recommended dose adjustments (cont.) CCR-5 receptor antagonists ARV dose change RIF dose change Comments Maraviroc Maraviroc to 600 mg twice-daily Integrase inhibitors Raltegravir Raltegravir to 800 mg twice daily Dolutegravir Dolutegravir to 50 mg twice daily No change No change No change Use with caution, as there is no reported clinical experience with increased dose of maraviroc with rifampin Raltegravir trough concentrations still decreased, follow VL carefully follow VL carefully Elvitegravir, cobicistat, tenofovir, and emtricitabine (Stribild ) Stribild and rifampin should not be used together Marked decrease in elvitegravir and cobicistat concentrations predicted based on metabolic pathways of these drugs CDC 2013
28 ART and RFB recommended dose adjustments ARV ARV dose change RFB dose change Comments NNRTIs Efavirenz No change 600 mg (daily or thrice-weekly) Nevirapine No change No change RIF preferred Rilpivirine Contraindicated Significant decrease in Rilpivirine Etravirine No change No change Conc of both decreased Protease inhibitors Atazanavir (single agent or ritonavir boosted) Darunavir/r Fosamprenavir/r Saquinavir/r No change 150 mg daily No pub clinical experience Monitor closely for potential rifabutin toxicity uveitis, hepatotoxicity, and neutropenia No change 150 mg daily Monitor closely for potential rifabutin toxicity uveitis, hepatotoxicity, and neutropenia Lopinavir/ritonavir (Kaletra ) No change 150 mg daily Hepatotoxicity in healthy volunteers Better-tolerated among HIV+ already on LPV/r CDC 2013
29 ART and RFB recommended dose adjustments (cont.) ARV dose change RFB dose change Comments CCR-5 receptor antagonists Maraviroc No change No change No clinical experience; a significant interaction is unlikely, but this has not yet been studied Integrase inhibitors Raltegravir No change No change RAL conc Dolutegravir No change No change DOL conc Elvitegravir, cobicistat, tenofovir, and emtricitabine (Stribild ) Stribild and rifabutin should not be used together Marked elvitegravir, cobicistat conc Marked rifabutin CDC 2013
30 ART and TB treatment: Overlapping toxicities Adverse effect ART Anti-TB therapy Gastrointestinal AZT, ddi, PIs R,I,P, ethionamide, PAS, Clofazamine, linezolid Hepatotoxicity NVP, EFV, PIs, NRTIs R,I,P, ethionamide, quinolones, PAS Neuropathy D4T, ddi I, ethionamide, cycloserine, linezolid Renal dysfunction TDF Aminoglycosides and capreomycin Neuropsychiatric EFV Cycloserine, ethionamide, quinolones, INH Rash NVP, EFV, ABC R,I,P,E, streptomycin, quinolones, PSA, clofzamine Cytopenia AZT, 3TC R,I, Linezolid, rifabutin Cardiac conduction PIs Pancreatitis D4T, ddi Linezolid Lactic acidosis D4T, ddi Linezolid Bedaquiline, quinolone, clofazamine Lawn, BMC Medicine, 2013
31 ART and TB treatment: management of toxicities Upon re-challenge >90% patients tolerate medications without a recurrence of the adverse effect Hepatotoxicity Rates among HIV+ similar to HIV- Stop anti-tb tx if ALT > 3 x ULN + clinical sx, or if ALT > 5 x ULN even if no sx when ALT < 2 X ULN: restart RIF, then INH; +/- PZA depending on severity of hepatitis Consider other causes (HBV, HCV, etc.) ATS, Am J Respir Crit Care Med, 2006
32 Question 3a Which of the following are true in the management of TB in an HIV+ individual? A. Rifamycins should be avoided due to multiple ART and anti- TB medication interactions B. In an ART-naïve HIV+ patient, ART initiation should be deferred until after TB treatment is completed in order to avoid ART and anti-tb medication interaction D. Efavirenz requires dose adjustment when co-administered with rifampin E. Rifabutin requires dose adjustment when co-administered with Efavirenz
33 Question 3b 42 y/o HIV+ homeless man is diagnosed with pulmonary TB and started on RIPE. He has a history of significant mental health issues worsened on Atripla (efavirenz + truvada). Because of this (and in line with current US HIV-guidelines) you had previously switched his efavirenz to raltegravir last year. At his next follow-up visit, his viral load (previously undetectable) is now >1000. Assuming he has no new HIV resistance, and he has been adherent to both his ART and anti- TB therapy, you should A. Decrease his dose of rifampin B. Increase his dose of raltegravir from 400 mg PO BID to 800 mg PO BID C. Consider switching rifampin for rifabutin D. B or C
34 Question 3c 30 y/o HIV+ F has a h/o IVDU and ART medication adherence issues in the past, is being treated with a ritonavir-boosted protease inhibitor-based ART regimen. She develops cough, weight lost, and is found to have pulmonary TB. She does not want to change her ART regimen, and so you decide to initiate her anti-tb treatment with rifabutin instead of rifampin. You remember from your TB intensive course that her rifabutin needs to be dosed at 150 mg PO q day. Her life becomes chaotic and she discontinues her ART, but continues her anti-tb tx w/ DOT. In order to ensure that her anti-tb tx remains therapeutic, you should A. Increase her rifabutin from 150 to 300 mg PO Q day B. Switch her rifabutin to rifampin if she is not going to be taking ART C. Decrease her rifabutin from 150 to 75 mg PO Q day D. A or B
35 Immune Reconstitution Inflammatory Syndrome: IRIS IRIS: collection of inflammatory disorders Paradoxical worsening of preexisting infectious processes Following ART initiation in HIV-infected individuals Assoc w/ immune recovery ( CD4, VL) Risk Factors: CD4 and VL pre- ART, short time between TB tx and ART inititiation, but TB IRIS can occur at CD4 >200 Meintjes, Lancet ID, 2010
36 Immune Reconstitution Inflammatory Syndrome: associated OIs Paradoxical Tuberculosis 17% (8-45%) Cryptococcus 20% (4-49%) PML 17% KS 7-31 % Unmasking Tuberculosis 1-5% Cryptococcus 1-2% Haddow, PLoS One, 2012 Muller, Lancet Infectious Diseases, 2010
37 Immune Reconstitution Inflammatory Syndrome: associated OIs Muller, Lancet ID, 2010
38 TB IRIS Clinical manifestations Pulmonary TB Sx: fever, malaise, weight loss, and worsening respiratory symptoms Worsening CXR: new parenchymal opacities and progressive intrathoracic lymph node Extrapulmonary Worsening lymphadenitis, new pleural effusions, intracranial tuberculomas, worsening of meningitis or radiculomyelopathy cold abscesses Meintjes, Lancet ID, 2010
39 Immune Reconstitution Inflammatory Continue ART unless life-threatening Steroids RCT 4 wks prednisone vs. placebo for TB IRIS symptoms, improved CXR, hospitalization NSAIDS Syndrome: Treatment Meintjes, AIDS, 2010
40 Question 4a 23 y/o F from Ethiopia presents with weight, loss, fever, and cough. CXR shows RUL opacity. Sputum smear is neg, but she is initiated on RIPE due to concerns for PTB (NAAT does return positive for Mtb). As part of her TB w/u she is tested for HIV and found to be positive w/ CD4 48. Which of the following are true? A. ART should be initiated within 2 weeks B. ART should be initiated after she has completed initial phase of TB treatment C. ART should be initiated after she has completed continuation phase of TB treatment D. TB treatment should be stopped until after she has initiated ART and her VL is undetectable
41 Question 4b She initiates ART treatment and continues w/ RIPE. After 2 weeks she develops fever, and her CXR now shows worsening pulmonary infiltrates You should A. Stop ART B. Collect sputum looking for MDR TB and add moxifloxacin and amikacin while waiting C. Stop ART therapy and start prednisone D. Continue anti-tb tx and ART, evaluate the patient for other infections, failed TB therapy and drug toxicity and consider starting prednisone
42 TB and HIV
43 LTBI and HIV
44 LTBI diagnostics in HIV+ TST TST+ > 5 mm (HIV+) Sensitivity 34-82% Specificity 56 95% False positive: BCG, NTM False negative: anergy with lower CD4 IGRA IGRA+ TB ag - nil > 0.35 IU/mL (+/- HIV) Sensitivity 58-74% Specificity 92 97% False positive: NTM (though less crossreactivity) Indeterminates w/ lower CD4 Pai, CMR, 2014 Cattamanchi, JAIDS, 2011 Santin, PloSONE, 2012
45 LTBI diagnostics TST Both TST/IGRA are indirect measures of M. tuberculosis infection. Require both infection and a functioning immune system for a positive test. Both may take 2-10 weeks to become positive after an exposure IGRA
46 LTBI diagnostics TST IGRA Either TST or IGRA can be used to diagnose LTBI in HIV+ Decision should be based on context for testing, test availability, and overall cost effectiveness of testing IGRA preferred if low rates of TST return for read, previous BGC vaccination Important to repeat testing when CD4 >200 False negatives due to anergy (immunosuppression) MMRW 2010 DHHS 2015
47 Question 5a Which of the following are true? A. IGRA is the recommended LTBI diagnostic of choice for HIV+ in the US B. TST and IGRA are direct measures of M. tuberculosis infection C. IGRA LTBI testing should be repeated if initially negative once CD4 >200 D. BCG can cause false positive IGRA E. There are separate cut-offs of a positive QFT for HIV+
48 Question 5b In a person with advanced HIV, a TST can be negative in the setting of A. Anergy (immunosuppression) B. Lack of infection with M. tuberculosis C. Recent infection within past few weeks D. All of the above
49 LTBI treatment in HIV+ Drug(s) Duration Interval Comment Isoniazid 9 months Daily Recommended Twice weekly Isoniazid + Rifapentine 3 months Once weekly Not on ART only Rifampin 4 months Daily Drug interactions May required dose adjustment Rifabutin 4 months Daily Drug interactions May required dose adjustment Rifampin + Pyrazinamide 2 months Daily Contraindicated
50 Why start ART + IPT? ART+IPT vs. ART Reduced risk of death or severe HIV-related illness ahr 0.65 ( ) Similar for CD4 >500 TEMPRANO, NEJM 2015
51 3HP and HIV? Sterling, AIDS 2016
52 3HP and HIV? 3HP non-inferior to 9H completion rates discontinuation due to hepatotoxicity Sterling, AIDS 2016
53 Question 6 You are seeing a 45 year old HIV+ male HCW well controlled on ART w/ CD4>500 who recently converted his TST after a medical mission trip in Haiti. TB symptom screen and CXR is negative, and you recommend initiating LTBI therapy. He s heard about a new short course LTBI treatment that you only have to take once a week and wants to know what his options are. Based on CDC/ATS/DHHS guidelines you recommend: A. INH x 9 months (daily) B. RIF x 4 months (daily) C. RIF + PZA x 2 months (daily) D. INH + RPT x 3 months (weekly)
54 HIV/TB take home points HIV/TB global co-epidemics, HIV significantly increase risk of TB Screening and diagnosis similar to non-hiv, but atypical presentations of PTB, EPTB and disseminated TB TB treatment similar to non-hiv, but Daily Initial phase w/ RIPE, and at least 3 x week Maintenance w/ IR Rifamycin-based anti-tb therapy is key, EFV-base ART preferred Rifabutin may have ART interaction, but requires dose adjustment Important to monitor for drug-drug interactions and side effects IRIS typically managed w/ NSAIDS, steroids if severe Concerns for TB-IRIS should not delay HAART initiation
55 HIV/LTBI take home points Either IGRA or TST can be used to diagnose LTBI in HIV Consider local factors, cost, risk of not returning Repeat test once CD4 >200 (if initial test negative) Preferred LTBI treatment is INH x 9 months 3 HP should be used only in HIV+ not on ART due to concerns for drug-drug interactions (though guidelines may change in future)
56 Resources Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the CDC, NIH, HIVMA, IDSA. Updated May 3, Mycobacterium tuberculosis Infection and Disease. Updated May 7, CDC. Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis Curry International Tuberculosis Center. TB Prevention in the HIV-infected Patient: Screening, Testing, and Treatment of Latent TB Infection online course. Andersen P, Munk ME, Pollock JM, Doherty TM. Specific immune-based diagnosis of tuberculosis. Lancet Sep 23;356(9235): CDC. Treatment of Tuberculosis. ATS, CDC, IDSA. MMWR 2003;52(No. RR-11). CDC. Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection, United States. (PDF) MMWR 2010; 59 (No.RR-5). Cattamanchi A, Smith R, Steingart KR, Metcalfe JZ, Date A, Coleman C, Marston BJ, Huang L, Hopewell PC, Pai M. Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis. J Acquir Immune Defic Syndr Mar 1;56(3): WHO. Global Tuberculosis Report
57 Additional Slides
58 TB symptom screening in HIV: a global perspective WHO recommends that all PLWHIV be screened for TB Negative sx - unlikely to have active TB and should be offered isoniazid preventive therapy Positive sx require further evaluation WHO TB symptom screen Cough Fever Weight loss Night sweats WHO 2011
59 WHO TB symptom screen in HIV+ Meta-analysis of 8,148 HIV+ 4 sx: cough, fever, night sweats, or weight loss 80% sensitive, 50% specificity Getahun, PlosMed 2011
60 TB rapid diagnostics Xpert MTB/RIF DNA PCR probes detect wild type sequence rpob gene RIF resistance = MDR proxy WHO 2013
61 TB screening and diagnostic tests: a global perspective Culture Symptom screen Smear Xpert DNA PCR Cost $$$ $ $ $$ Resource requirement Sensitivity Gold variable Low in HIV High standard Results 3 weeks 5 mins <24 hrs 2 hours Resistance testing Yes No No Yes Optimal test: inexpensive, rapid, accurate culture smear Xpert
62 TB diagnostic performance in HIV Xpert improved sensitivity compared to smear in HIV Smear Xpert Sensitivity Specificity Sensitivity Specificity Steingart, Cochrane 2014 Lawn, BMC ID 2013 Drain, Lancet ID 2014
63 Xpert MTB/RIF WHO recommends Xpert should be used as the initial test rather than microscopy, culture MDR-TB suspects HIV associated TB in both adults and children Can be used All adult/child TB suspects Follow-up test in smear negative TB suspects WHO 2013
64 Supplemental Question The WHO recommends which of the following as the first-line TB diagnostic in HIV+ in low-resource settings? A. Smear microscopy B. Xpert C. Culture D. TB-sniffing African giant pouched rat smear Xpert culture African giant pouched rat
65 Optimal length of IPT in high WHO now recommends 36 months of IPT for HIV+ in high TB/HIV settings BOTUSA 2011 Significant risk of TB with 36 vs. 6 months IPT HR 0 57 ( ), p=0. 047) burden settings?
TB in the Patient with HIV
TB in the Patient with HIV Lisa Y. Armitige, MD, PhD May 11, 2017 TB Intensive May 9 12, 2017 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD, has the following disclosures to
More informationCase Management of the TB/HIV Infected Patient
TB Nurse Case Management San Antonio, Texas December 8-10, 2009 Case Management of the TB/HIV Infected Patient Sarah Hoffman, MPH, MSN, ACRN December 9, 2009 TB/HIV: Considerations in the Care of the Coinfected
More informationTB/HIV and other immunosuppressive states
TB/HIV and other immunosuppressive states Sylvia LaCourse MD, MPH Department of Medicine, Division of Allergy & Infectious Disease TB Clinical Intensive Seattle, WA June 14 15, 2018 Roadmap for today s
More information8/28/2017. Learning Objectives. After attending this presentation, learners will be able to:
New and Noteworthy in Tuberculosis Diagnostics and Treatment Susan Swindells, MBBS Professor of Internal Medicine University of Nebraska Medical Center Omaha, Nebraska San Antonio, Texas: August 21 to
More informationApproach to Co-infection with TB and HIV: 2011 Henry Fraimow, MD
Approach to Co-infection with TB and HIV: 2011 Henry Fraimow, MD Consultant, Southern N.J. Regional Chest Clinic New Jersey State TB Physician Advisory Board Cooper Univ. Hospital EIP Program TB and HIV
More informationHIV/TB Co infection TB Clinical Intensive October 11, 2018
HIV/TB Co infection TB Clinical Intensive October 11, 2018 Gabriel Chamie, MD, MPH Associate Professor of Medicine Division of HIV, Infectious Diseases & Global Medicine UCSF/San Francisco General Hospital
More informationClinical Vignette: Patient 1. Approach to Co-infection with TB. TB and HIV Co-infection: Some Resources. Objectives.
TB and HIV Co-infection: Some Resources http://www.cdc.gov/tb AETC Natl Resource Center: http://www.aidsetc.org Approach to Co-infection with TB and HIV: 2012 Henry Fraimow, MD Consultant, Southern N.J.
More informationCLINICAL VIGNETTE: Patient 1. Approach to Co-infection with TB and HIV: TB and HIV Co-infection: Some Resources. Goals and Objectives
TB and HIV Co-infection: Some Resources http://www.cdc.gov/tb http://www.umdnj.edu/globaltb/coretbresources.htm Approach to Co-infection with TB and HIV: 2011 Henry Fraimow, MD Consultant, Southern N.J.
More informationTB Intensive San Antonio, Texas May 7-10, 2013
TB Intensive San Antonio, Texas May 7-10, 2013 TB in the HIV Patient Lisa Armitige, MD, PhD May 09, 2013 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interests No relevant
More informationTB Intensive Tyler, Texas December 2-4, Tuberculosis and HIV Co-Infection. Lisa Y. Armitige, MD, PhD. December 4, 2008.
TB Intensive Tyler, Texas December 2-4, 2008 Tuberculosis and HIV Co-Infection Lisa Y. Armitige, MD, Ph.D. December 4, 2008 Tuberculosis and HIV Co Infection Lisa Y. Armitige, MD, PhD Assistant Professor
More information10/3/2017. Updates in Tuberculosis. Global Tuberculosis, WHO 2015 report. Objectives. Disclosures. I have nothing to disclose
Disclosures Updates in Tuberculosis I have nothing to disclose Chris Keh, MD Assistant Clinical Professor, Division of Infectious Diseases, UCSF TB Controller, TB Prevention and Control Program, Population
More informationTB Intensive San Antonio, Texas. TB/HIV Co-Infection. Lisa Armitige, MD, PhD has the following disclosures to make:
TB Intensive San Antonio, Texas August 2-5, 2011 TB/HIV Co-Infection Lisa Armitige, MD, PhD August 4, 2011 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interests No relevant
More informationTuberculosis Intensive
Tuberculosis Intensive San Antonio, Texas April 3 6, 2012 TB in the HIV Patient Lisa Armitige, MD, PhD April 6, 2012 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interests
More informationTB/HIV Co-Infection. Tuberculosis and HIV
TB Intensive Tyler, Texas June 2-4, 2010 TB/HIV Co-Infection Lisa Y Armitige, MD, PhD June 3, 2010 Tuberculosis and HIV Co-Infection Lisa Y Armitige, MD, PhD Medical Consultant Heartland National TB Center
More information5. HIV-positive individuals treated with INH should receive Pyridoxine (B6) 25 mg daily or 50 mg twice/thrice weekly on the same schedule as INH
V. TB and HIV/AIDS A. Standards of Treatment and Management The majority of TB treatment principles apply to persons with HIV/AIDS who require treatment for TB disease. The following points are either
More informationDiagnosis and Treatment of Tuberculosis, 2011
Diagnosis of TB Diagnosis and Treatment of Tuberculosis, 2011 Alfred Lardizabal, MD NJMS Global Tuberculosis Institute Diagnosis of TB, 2011 Diagnosis follows Suspicion When should we Think TB? Who is
More informationTuberculosis: update 2013
Tuberculosis: update 2013 William R. Bishai, MD, PhD Center for TB Research Division of Infectious Diseases Department of Medicine Johns Hopkins School of Medicine Question 1 A TB speaker at a major conference
More informationTB: Management in an era of multiple drug resistance. Bob Belknap M.D. Denver Public Health November 2012
TB: Management in an era of multiple drug resistance Bob Belknap M.D. Denver Public Health November 2012 Objectives: 1. Explain the steps for diagnosing latent and active TB role of interferon-gamma release
More informationImmune Reconstitution Inflammatory Syndrome. Dr. Lesego Mawela
Immune Reconstitution Inflammatory Syndrome Dr. Lesego Mawela TOPICS FOR DISCUSSION IRIS Case Epidermiology Pathogenesis of IRIS Risk factors for IRIS Epidemiology of IRIS Health system burden of IRIS
More informationErrors in Dx and Rx of TB
Errors in Dx and Rx of TB David Schlossberg, MD, FACP Professor of Medicine Temple University School of Medicine Medical Director, TB Control Program Philadelphia Department of Public Health TB Still a
More informationPrinciples of Antiretroviral Therapy
Principles of Antiretroviral Therapy Ten Principles of Antiretroviral Therapy Skills Building Workshop: Clinical Management of HIV Infection and Antiretroviral Therapy, 11 th ICAAP, November 21st, 2011,
More informationTuberculosis Tools: A Clinical Update
Tuberculosis Tools: A Clinical Update CAPA Conference 2014 JoAnn Deasy, PA-C. MPH, DFAAPA jadeasy@sbcglobal.net Adjunct Faculty Touro PA Program Learning Objectives Outline the pathogenesis of active pulmonary
More informationTB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011
TB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011 OUTLINE Background Global Incidence The Problem" The 3 I s Drug Resistant
More informationDIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE
DIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE Annie Kizilbash MD, MPH Assistant Professor University of Texas Health Science Center Staff Physician, Texas Center for Infectious Diseases TB Nurse Case
More informationTreatment of Tuberculosis
TB Clinical i l Intensive Seattle Treatment of Tuberculosis June 16, 2016 Masa Narita, MD Public Health Seattle & King County; Firland Northwest TB Center, University of Washington Outline Unique features
More informationhas the following disclosures to make:
CLINICAL DIAGNOSIS AND MANAGEMENT OF TB DISEASE Annie Kizilbash MD, MPH September 22, 2015 TB Nurse Case Management September 22 24, 2015 San Antonio. TX EXCELLENCE EXPERTISE INNOVATION Annie Kizilbash
More informationRajesh T. Gandhi, M.D.
HIV Treatment Guidelines: 2010 Rajesh T. Gandhi, M.D. Case 29 yo M with 8 weeks of cough and fever. Diagnosed with smear-positive pulmonary TB. HIV-1 antibody positive. CD4 count 361. HIV-1 RNA 23,000
More informationSA TB Guidelines The interface with Advanced Clinical Care
SA TB Guidelines The interface with Advanced Clinical Care Dr Kogie Naidoo (MBCHB, PHD) Head: CAPRISA Treatment Research Programme Honorary Lecturer - UKZN Department of Public Heath Medicine Annual Workshop
More informationPediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017
Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has the following disclosures
More informationTuberculosis Intensive
Tuberculosis Intensive San Antonio, Texas April 3 6, 2012 Childhood Tuberculosis Kim Smith, MD, MPH April 6, 2012 Kim Smith, MD, MPH has the following disclosures to make: No conflict of interests No relevant
More informationMycobacterial Infections: What the Primary Provider Should Know about Tuberculosis
Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Epidemiology Diagnosis of active TB Screening
More informationTB Intensive Houston, Texas. Childhood Tuberculosis Kim Connelly Smith. November 12, 2009
TB Intensive Houston, Texas November 10-12, 12 2009 Childhood Tuberculosis Kim Connelly Smith MD, MPH November 12, 2009 Childhood Tuberculosis Kim Connelly Smith MD, MPH November 12, 2009 1 OUTLINE Stages
More informationPreventing TB: Recent Research Results and Novel Short Course Therapy for LTBI
Preventing TB: Recent Research Results and Novel Short Course Therapy for LTBI Constance A. Benson, M.D. Professor of Medicine Director, UCSD AntiViral Research Unit PI, CD4 Collaborative HIV Clinical
More informationTuberculosis, HIV, and Corrections James B. McAuley, MD, MPH April 22, 2009
TB in the Correctional Setting Collinsville, Illinois April 22, 2009 Tuberculosis, HIV, and Corrections James B. McAuley, MD, MPH April 22, 2009 Tuberculosis, HIV, and Corrections James B. McAuley, MD
More informationMoving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012
Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 LTBI and TB Disease Treatment Cara Christ, MD, MS May 8, 2012 Cara Christ, MD, MS has the following disclosures to make: No conflict
More informationTB & HIV CO-INFECTION IN CHILDREN. Reené Naidoo Paediatric Infectious Diseases Broadreach Healthcare 19 April 2012
TB & HIV CO-INFECTION IN CHILDREN Reené Naidoo Paediatric Infectious Diseases Broadreach Healthcare 19 April 2012 Introduction TB & HIV are two of the leading causes of morbidity & mortality in children
More informationLatent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016
Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016 Randy Culpepper, MD, MPH Deputy Heath Officer/Medical Director Frederick County Health Department March 16, 2016 2 No
More information1/18/2011. Handling TB and HIV. Fargo, North Dakota September 15-16, Treatment of TB in the HIV Co-Infected Patient
1/18/2011 Handling TB and HIV Co-Infection Fargo, North Dakota September 15-16, 2010 Treatment of TB in the HIV Co-Infected Patient Dean Tsukayama, MD September 15, 2010 1 Co-infection with TB and HIV
More informationWhat you need to know about diagnosing and treating TB: a preventable, fatal disease. Bob Belknap M.D. Denver Public Health November 2013
What you need to know about diagnosing and treating TB: a preventable, fatal disease Bob Belknap M.D. Denver Public Health November 2013 Case 1: 52 y/o male Born in the Pacific Islands; some travel in
More informationTB in Prisons and Jails Albuquerque, New Mexico November 28, 2012
TB in Prisons and Jails Albuquerque, New Mexico November 28, 2012 Challenges of TB Treatment in Special Populations in Corrections Marcos Burgos, MD November 28, 2012 Marcos Burgos, MD has the following
More informationTB in the Correctional Setting Florence, Arizona October 7, 2014
TB in the Correctional Setting Florence, Arizona October 7, 2014 Diagnosis and Treatment of TB Disease Renuka Khurana, MBBS, MPH October 7, 2014 Renuka Khurana, MSSB, MPH has the following disclosures
More informationTB Nurse Case Management San Antonio, Texas July 18 20, 2012
TB Nurse Case Management San Antonio, Texas July 18 20, 2012 Pediatric TB Kim Smith, MD, MPH July 19, 2012 Kim Smith, MD, MPH has the following disclosures to make: No conflict of interests No relevant
More informationPediatric TB Lisa Armitige, MD, PhD September 28, 2011
TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Pediatric TB Lisa Armitige, MD, PhD September 28, 2011 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interest.
More informationHIV Treatment Update. Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University
HIV Treatment Update Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University Outline Rationale for highly active antiretroviral therapy (HAART) When to start
More informationTB Nurse Case Management San Antonio, Texas March 7 9, Pediatric TB Kim Connelly Smith, MD, MPH March 8, 2012
TB Nurse Case Management San Antonio, Texas March 7 9, 2012 Pediatric TB Kim Connelly Smith, MD, MPH March 8, 2012 Kim Connelly Smith, MD, MPH has the following disclosures to make: No conflict of interests
More informationMDR TB/HIV INTEGRATION MDR TB WORKSHOP 18 SEPTEMBER 2015
MDR TB/HIV INTEGRATION MDR TB WORKSHOP 18 SEPTEMBER 2015 HIV & MDR :Impact of early ART initiation Adjusted HR: 0.14; p = 0.042 86% reduction in mortality with ART Initiation during MDR-TB treatment 2015
More informationTB Update: March 2012
TB Update: March 2012 David Schlossberg, MD, FACP Medical Director, TB Control Program Philadelphia Department of Public Health 1 TB Update: March 2012 IGRAs vs TST LTBI A New Regimen NAATs What is Their
More informationDiagnosis & Medical Case Management of TB Disease. Lisa Armitige, MD, PhD October 22, 2015
Diagnosis & Medical Case Management of TB Disease Lisa Armitige, MD, PhD October 22, 2015 Comprehensive Care of Patients with Tuberculosis and Their Contacts October 19 22, 2015 Wichita, KS EXCELLENCE
More informationDiagnosis and Medical Management of Latent TB Infection
Diagnosis and Medical Management of Latent TB Infection Marsha Majors, RN September 7, 2017 TB Contact Investigation 101 September 6 7, 2017 Little Rock, AR EXCELLENCE EXPERTISE INNOVATION Marsha Majors,
More informationPre-Treatment Evaluation. Treatment of Latent TB Infection (LTBI) Initiating Treatment: Patient Education. Before initiating treatment for LTBI:
Pre-Treatment Evaluation Before initiating treatment for LTBI: Treatment of Latent TB Infection (LTBI) Amee Patrawalla, MD Associate Professor, New Jersey Medical School Attending Physician, NJMS Global
More informationNon-rifampin rifamycins in TB/HIV
Non-rifampin rifamycins in TB/HIV Richard E. Chaisson, MD Johns Hopkins University Center for TB Research Consortium to Respond Effectively to the AIDS-TB Epidemic Rifamycins for TB Inhibit bacterial DNA-dependent
More informationTreatment of Active Tuberculosis
Treatment of Active Tuberculosis Jeremy Clain, MD Pulmonary & Critical Care Medicine Mayo Clinic October 16, 2017 2014 MFMER slide-1 Disclosures No relevant financial relationships No conflicts of interest
More informationTB and Comorbidities Adriana Vasquez, MD April 12, 2018
TB and Comorbidities Adriana Vasquez, MD April 12, 2018 TB Nurse Case Management April 10 12, 2018 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Adriana Vasquez, MD has the following disclosures to make:
More informationDiagnosis and Medical Management of TB Disease. Quratulian Annie Kizilbash, MD, MPH March 17, 2015
Diagnosis and Medical Management of TB Disease Quratulian Annie Kizilbash, MD, MPH March 17, 2015 TB Nurse Case Management March 17 19, 2015 San Antonio, Texas EXCELLENCE EXPERTISE INNOVATION Quratulian
More informationDisclosures. Updates in TB for the PCP: Opportunities for Prevention. Objectives PART 1: WHY TEST? 4/14/2016. None
Disclosures Updates in TB for the PCP: Opportunities for Prevention None Pennan Barry, MD, MPH Chief, Surveillance and Epidemiology, California TB Control Branch Assistant Clinical Professor, Division
More informationHIV and TB coinfection: Updates. Awewura Kwara, MD, MPH &TM Associate Professor, Alpert Medical School of Brown University
HIV and TB coinfection: Updates Awewura Kwara, MD, MPH &TM Associate Professor, Alpert Medical School of Brown University Learning objectives Identify the optimal timing of antiretroviral therapy in patients
More informationTUBERCULOSIS. Presented By: Public Health Madison & Dane County
TUBERCULOSIS Presented By: Public Health Madison & Dane County What is Tuberculosis? Tuberculosis, or TB, is a disease caused by a bacteria called Mycobacterium tuberculosis. The bacteria can attack any
More informationContact Investigation and Prevention in the USA
Contact Investigation and Prevention in the USA George D. McSherry, MD Division of Infectious Disease Penn State Children s Hospital Pediatric Section TB Center of Excellence Rutgers Global Tuberculosis
More informationWhat you need to know about diagnosing and treating TB: a preventable, fatal disease. Bob Belknap M.D. Denver Public Health November 2014
What you need to know about diagnosing and treating TB: a preventable, fatal disease Bob Belknap M.D. Denver Public Health November 2014 The Critical First Step Consider TB in the Differential 1. Risks
More informationWhat the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Global Impact of TB
What the Primary Physician Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Epidemiology Common disease presentations Diagnosis of active TB Screening
More informationTB In Detroit 2011* Early TB: Smudge Sign. Who is at risk for exposure to or infection with TB? Who is at risk for TB after exposure or infection?
Those oral antibiotics are just not working! Inpatient Standards of Care & Discharge Planning S/He s in the Hospital: Now What Do I Do? Dana G. Kissner, MD TB Intensive Workshop, Lansing, MI 2012 Objectives:
More informationTreatment of Tuberculosis, 2017
Treatment of Tuberculosis, 2017 Charles L. Daley, MD National Jewish Health University of Colorado Health Sciences Center Treatment of Tuberculosis Disclosures Advisory Board Horizon, Johnson and Johnson,
More informationGuidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail notification of guideline
More informationINH Prophylaxis Therapy (IPT) should NOT be implemented for all HIV patients in the Asia Pacific
INH Prophylaxis Therapy (IPT) should NOT be implemented for all HIV patients in the Asia Pacific Thuy Le, MD DPhil Duke University School of Medicine, USA Oxford University Clinical Research Unit Hospital
More informationCHAPTER:1 TUBERCULOSIS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:1 TUBERCULOSIS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY GLOBAL EMERGENCY: * Tuberculosis kills 5,000 people a day! * 2.3 million die each year!
More informationTuberculosis and Diabetes Mellitus. Lana Kay Tyer, RN MSN WA State Department of Health TB Nurse Consultant
Tuberculosis and Diabetes Mellitus Lana Kay Tyer, RN MSN WA State Department of Health TB Nurse Consultant Learning Objectives Understand the impact of uncontrolled diabetes mellitus (DM) on TB infection
More informationCLINICAL DIAGNOSIS AND MANAGEMENT OF TB Disease
CLINICAL DIAGNOSIS AND MANAGEMENT OF TB Disease Barbara J Seaworth MD Medical Director Heartland National TB Center Professor of Medicine University of Texas Health Center Tyler Barbara J Seaworth MD has
More informationSharing the Care: Working Together on LTBI Treatment and Management Webinar. September 24, Curry International Tuberculosis Center
TB Infection Diagnostics and Treatment Neha Shah MD MPH Field Medical Officer Tuberculosis Control Branch California Department of Public Health Centers for Disease Control and Prevention 1 Curry International
More informationTuberculosis: Where Are We Now?
Tuberculosis: Where Are We Now? Amee Patrawalla MD MPH Rutgers - NJ Medical School Global TB Institute Rutgers, The State University of New Jersey Learning Objectives Understand the current epidemiologic
More informationNurse Case Management Phoenix, Arizona February 20-22, 2008
Nurse Case Management Phoenix, Arizona February 20-22, 2008 TB/HIV: Managing the Co-Infected Patient Adriana Vasquez, MD February 21, 2008 HIV Treatment Guidelines DHHS December 1,2007 TB/HIV Managing
More information"Sterilization of TB disease in
11/1/1 "Sterilization of TB disease in mice " Jacques Grosset Pharmacodynamics of daily rifapentine and rifampin in mice Free rifam mycin Concentrati ion/mic 1 1 Rifapentine (1mg/kg) Free rifam mycin Concentrati
More informationTB Nurse Case Management San Antonio, Texas April 9-11, 2013
TB Nurse Case Management San Antonio, Texas April 9-11, 2013 TB / Dose Counting Rachel Munoz, RN. TB Nurse Case Manager/Nurse Consultant Austin/Travis County Health Department April 10, 2013 Rachel Munoz,
More informationGary Reubenson 16 October 2012 PAEDIATRIC TUBERCULOSIS: AN OVERVIEW IN 40 MINUTES!!
Gary Reubenson 16 October 2012 PAEDIATRIC TUBERCULOSIS: AN OVERVIEW IN 40 MINUTES!! DECLARATION No relevant conflicts of interest to declare OVERVIEW Burden of disease & epidemiology Pathogenesis (not
More informationTreatment experience in South Africa. Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand
Treatment experience in South Africa Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand Overview South African Prevalence Adherence Combination ddi + d4t Nevirapine Hepatotoxicity
More informationTB in Corrections Phoenix, Arizona
TB in Corrections Phoenix, Arizona March 24, 2011 Treatment of Latent TB Infection Renuka Khurana MD, MPH March 24, 2011 Renuka Khurana, MD, MPH has the following disclosures to make: No conflict of interests
More informationTB Intensive San Antonio, Texas August 7-10, 2012
TB Intensive San Antonio, Texas August 7-10, 2012 An Introduction to Childhood Tuberculosis Kim Smith, MD, MPH August 10, 2012 Kim Smith, MD, MPH has the following disclosures to make: No conflict of interests
More informationDiagnosis and Management of TB Disease Lisa Armitige, MD, PhD September 27, 2011
TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Diagnosis and Management of TB Disease Lisa Armitige, MD, PhD September 27, 2011 Lisa Armitige, MD, PhD has the following disclosures to make:
More informationPediatric TB Intensive Houston, Texas October 14, 2013
Pediatric TB Intensive Houston, Texas October 14, 2013 Diagnosis and Management of Tuberculosis in Adolescents Andrea T. Cruz, MD, MPH Sections of Infectious Diseases & Emergency Medicine October 14, 2013
More informationTreatment of Tuberculosis
Treatment of Tuberculosis Marcos Burgos, MD April 5, 2016 TB Intensive April 5 8, 2016 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Marcos Burgos, MD has the following disclosures to make: No conflict
More informationWhat Is New in Combination TB Prevention? Lisa J. Nelson Treatment and Care (TAC) Team HIV Department WHO HQ
What Is New in Combination TB Prevention? Lisa J. Nelson Treatment and Care (TAC) Team HIV Department WHO HQ Outline Combination prevention for HIV Approaches to TB prevention Individual Household/key
More informationDifference of opinion? Michelle Moorhouse 24 Sep 2014
Difference of opinion? Michelle Moorhouse 24 Sep 2014 Meet NN 52 years, female Nurse in pre-art clinic Referred Feb 2012 by dermatologist History of severe reactions to ART Erythema and bullous eruptions
More informationHot Issues in Tuberculosis: Treatment of Latent TB Infection and New TB Drugs
Slide 1 Hot Issues in Tuberculosis: Treatment of Latent TB Infection and New TB Drugs Constance A. Benson, M.D. Professor of Medicine Division of Infectious Diseases University of California, San Diego
More informationWhat more is required to use rifamycin regimens to prevent TB in people living with HIV in resource constrained settings?
What more is required to use rifamycin regimens to prevent TB in people living with HIV in resource constrained settings? Gary Maartens Division of Clinical Pharmacology UNIVERSITY OF CAPE TOWN IYUNIVESITHI
More informationTUBERCULOSIS. Pathogenesis and Transmission
TUBERCULOSIS Pathogenesis and Transmission TUBERCULOSIS Pathogenesis and Transmission Infection to Disease Diagnostic & Isolation Updates Treatment Updates Pathogenesis Droplet nuclei of 5µm or less are
More informationTuberculosis in Primary Care COC GTA Spring Symposium Dr Elizabeth Rea April 2013
Tuberculosis in Primary Care COC GTA Spring Symposium Dr Elizabeth Rea April 2013 1 TB in Toronto - risk groups Diagnosis of active TB LTBI diagnosis and management Infection control 2 TB in Toronto Case
More informationThe diagnosis, management and prevention of HIV-associated tuberculosis
REVIEW The diagnosis, management and prevention of HIV-associated tuberculosis S Wasserman, 1 MB ChB, MMed, FCP (SA), Cert ID (SA) Phys; G Meintjes, 1,2 MB ChB, FRCP (Glasg), FCP (SA), Dip HIV Man, MPH,
More informationOutline. A 41 Year-old Male COMMON PITFALLS IN HIV/AIDS MANAGEMENT: A CASE-BASED APPROACH. Q1: What anti-fungal regimen would you start?
Outline COMMON PITFALLS IN HIV/AIDS MANAGEMENT: A CASE-BASED APPROACH Considerations for antiretroviral use in patients with coinfections Concerning and how to manage drug-drug interactions ARV-other drugs
More informationDrug Interactions Lisa Armitige, MD, PhD November 17, 2010
Substance Abuse and Tuberculosis Oklahoma City, Oklahoma November 17, 2010 Drug Interactions Lisa Armitige, MD, PhD November 17, 2010 Drug Interactions Lisa Y. Armitige, M.D., Ph.D. Medical Consultant
More informationCase Presentations Part 2
Case Presentations Part 2 Connie A. Haley, MD MPH University of Florida, Infectious Diseases and Global Medicine Megan Ninneman, PA Jackson Memorial Hospital, Miami FL Objectives Demonstrate the ability
More informationComprehensive Guideline Summary
Comprehensive Guideline Summary Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents AETC NRC Slide Set Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and
More informationWESTERN CAPE ART GUIDELINES PRESENTATION 2013
WESTERN CAPE ART GUIDELINES PRESENTATION 2013 The WC guidelines are based on SA National ART guidelines dated 24th March 2013 Acknowledgement goes to members of the Adult and Paediatric HAST policy advisory
More informationLatent TB Infection (LTBI) Strategies for Detection and Management
Latent TB Infection (LTBI) Strategies for Detection and Management Patrick T. Dowling MD,MPH Professor and Chair Dept of Family Medicine David Geffen School of Medicine at UCLA Pri-Med March 29 2014 Pdowling@mednet.ucla.edu
More informationTuberculosis in AIDS Patients. Chien-Ching Hung Division of Infectious Diseases Department of Internal Medicine National Taiwan University Hospital
Tuberculosis in AIDS Patients Chien-Ching Hung Division of Infectious Diseases Department of Internal Medicine National Taiwan University Hospital Topics Epidemiology of TB in the era of HIV epidemic Impact
More informationDidactic Series. Latent TB Infection in HIV Infection
Didactic Series Latent TB Infection in HIV Infection Jacqueline Peterson Tulsky, MD UCSF Positive Health Program at SFGH Medical Director, SF and North Coast AETC March 13, 2014 ACCREDITATION STATEMENT:
More informationTB in Children. Rene De Gama Block 10 Lectures 2012
TB in Children Rene De Gama Block 10 Lectures 2012 Contents Epidemiology Transmission and pathogenesis Diagnosis of TB TB and HIV Management Epidemiology The year 2000 8.3 million new TB cases diagnosed
More informationTB BASICS: PRIORITIES AND CLASSIFICATIONS
TB CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE NOVEMBER 1-4, 2016 TB BASICS: PRIORITIES AND CLASSIFICATIONS LEARNING OBJECTIVES Upon completion of this session, participants will be able to: 1.
More informationTuberculosis. WRAIR- GEIS 'Operational Clinical Infectious Disease' Course UNCLASSIFIED
Tuberculosis WRAIR- GEIS 'Operational Clinical Infectious Disease' Course UNCLASSIFIED Acknowledgments COL Paul Keiser LTC James E. Moon LTC Jaime Mancuso LTC Anjali Kunz MAJ Kristopher Paolino MAJ Leyi
More informationChapter 5 Treatment for Latent Tuberculosis Infection
Chapter 5 Treatment for Latent Tuberculosis Infection Table of Contents Chapter Objectives.... 109 Introduction.... 111 Candidates for the Treatment of LTBI... 112 LTBI Treatment Regimens.... 118 LTBI
More informationDiagnosis of tuberculosis in children
Diagnosis of tuberculosis in children H Simon Schaaf Desmond Tutu TB Centre Department of Paediatrics and Child Health, Stellenbosch University, and Tygerberg Children s Hospital (TCH) Estimated TB incidence
More informationRecognizing MDR-TB in Children. Ma. Cecilia G. Ama, MD 23 rd PIDSP Annual Convention February 2016
Recognizing MDR-TB in Children Ma. Cecilia G. Ama, MD 23 rd PIDSP Annual Convention 17-18 February 2016 Objectives Review the definitions and categorization of drugresistant tuberculosis Understand the
More information