Tuberculosis and HIV disease

November 2004     View PDF     En español

Treating active TB

The effectiveness of anti-TB treatment is quite good, regardless of HIV infection. However, it is vital that people take the full course of drugs in order to kill all the TB and to prevent the development of anti-TB drug resistance or recurrence of active TB disease. People on anti-TB drugs are generally encouraged to see their doctors at least once a month and maybe more often at the start of treatment. This is to check whether the drugs are working, to identify adherence problems (problems with taking the drugs as prescribed), and to monitor for side effects or reactions.

The treatment for TB in the lungs and other organs is the same and usually lasts for six months, although widespread TB may require taking anti-TB therapies for a longer period of time. Treating TB in the brain (meninges), bones or joints might require at least nine months of therapy. If anti-TB treatment doses are missed for any reason, longer courses of treatment are likely necessary. Also, people who don’t respond quickly to the normal course of therapy might need to continue on anti-TB for nine months or longer.

Symptoms of active TB disease usually ease off 3–4 weeks after starting anti-TB treatment. When a person has had three negative smear tests, he or she is considered to be non-infectious, or not likely to be able to infect others with TB. This usually occurs 2–3 months after starting anti-TB treatment.

The first line treatment for TB disease is a combination of four drugs that includes isoniazid (Nydrazid) (300mg/day), rifampin (Rifadin, Rimactane) (450–600mg/day), pyrazinamide (Tebrazid) (20–30mg/kg/day), and ethambutol (Myambutol) (15–25mg/kg/day) or streptomycin sulfate (15mg/kg/day). These five drugs are given and resistance testing is performed. If the resistance test shows that the TB can be killed by isoniazid and rifampin, then the ethambutol or streptomycin can be stopped. The U.S. Public Health guidelines recommend that people with HIV taking isoniazid also take pyridoxine (Vitamin B6) because they are at higher risk for developing peripheral neuropathy.

Six-month treatment plans for TB

Treatment plans for resistant TB