Guidelines for co-infected patients

New guidelines for treating and preventing tuberculosis among HIV-infected people held few surprises. The guidelines, issued by the Centers for Disease Control and Prevention in an Oct. 30, 1998, "Recommendation and Report" of the Morbidity and Mortality Weekly Report (Vol. 47) made the following points:

• All HIV-infected people should be screened for TB; if infected, they should be treated to prevent the development of active disease.

• Either preventive or curative regimens must be carefully evaluated to prevent drug interactions with new therapies for HIV. In particular, rifampin should not be given in combination with protease inhibitors or non-nucleoside reverse transcriptase inhibitors because it can seriously impair the effectiveness of these therapies.

• In such instances, the anti-TB drug rifabutin can be substituted safely for rifampin, allowing therapies for both TB and HIV to continue.

• Directly observed therapy should be provided.

• A new short-course regimen for preventing TB, consisting of daily therapy for two months with pyrazinamide and rifampin, now can be provided as an alternative to a yearlong course of isoniazid, the regimen previously prescribed for those co-infected with HIV and TB.