CDC prepares to update co-infection guideline

MMWR will summarize co-infection meeting

More than a year after it issued guidelines on how to treat tuberculosis patients infected with HIV, the Centers for Disease Control and Prevention is drafting guidelines that pull together the latest findings on protease inhibitor interactions and existing treatment statements into one document, CDC officials report.

After growing concern that providers were not aware of the interaction of protease inhibitors and rifampin and rifabutin, the CDC published guidelines in November 1996 that provided treatment options for patients infected with TB and HIV.1 (See TB Monitor, November 1996, p. 121.) Other treatment guidelines for co-infection have been issued by the American Thoracic Society and the CDC’s Advisory Committee for the Elimination of TB (ACET).

"It’s not so much that they are outdated but that they have never been published as a separate single publication, a freestanding document that addresses exclusively TB/HIV," says Elsa Villarino, MD, chief of the therapeutics and diagnostics section in the CDC’s division of TB elimination. "We will collate all that information and then update it with considerations, such as protease inhibitor interaction."

The new guidelines, which are expected to be published by this summer, will include a summary of data and discussions presented during a recent joint meeting of ACET and the CDC’s Advisory Committee for HIV and STD Prevention. One of the main issues discussed at the October meeting was concern about treating patients effectively for TB when they were receiving protease inhibitors, Villarino tells TB Monitor.

Although the CDC has updated information on how individual protease inhibitors interact with rifampin and rifabutin, the basic decision-making process over their use with TB patients still stands, and most clinicians are making treatment adjustments on a case-by-case basis, she adds.

The document also will provide guidance for preventive therapy in co-infected patients and will likely incorporate recent studies showing that short-course preventive therapy in HIV-positive patients is effective. (See TB Monitor article on preventive therapy, January 1998, pp. 1-3.) While the document will touch on preventive therapy in co-infected patients, the CDC will be revising its preventive therapy guidelines for TB patients following a consultants meeting in September, she adds.

Reference

1. Villarino E. Clinical update: Impact of HIV protease inhibitors on the treatment of HIV-infected tuberculosis patients with rifampin. MMWR 1996; 45:921-925.