Despite diagnosis and treatment, patients with HIV and TB infection still die. It is important that as many such patients as feasible are examined by autopsy. This categorizes the pathology LY2109761 supplier and enables audit of medical practice. The significant categories of causes of death include: active, progressive TB; Culture of tuberculous autopsy tissue should be performed routinely, to evaluate drug sensitivity and bacterial viability. Autopsies are either requested by clinicians or commanded by a Coroner (in UK) or Procurator Fiscal

(in Scotland). If the autopsy is coronial, every endeavour should be made to obtain the autopsy report for clinical audit. Before any autopsy, discussion about the clinico-pathological issues with the pathologist is recommended. More information at University of Liverpool website: http://www.hiv-druginteractions.org Dose adjustments are described below for antiretrovirals given with rifampicin, rifabutin and clarithromycin. No dosage adjustments are advised with isoniazid, pyrazinamide, streptomycin, amikacin, kanamycin, ethionamide, azithromycin, ofloxacin or ciprofloxacin. A four-drug regimen of rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months; followed

by rifampicin and isoniazid for 4 months. A prolonged treatment duration is recommended. TB meningitis is treated for at least see more 9 months. In MDR-TB, treatment for up to 2 years may be indicated. Daily therapy is recommended. If therapy is given three or five times per week it should be supervised, preferably as DOT. Patients with pre-existing liver disease need their liver function tests monitored closely. They need to be advised to present immediately if they develop vomiting, abdominal pain or jaundice. Molecular diagnostic tests can give rapid identification of mycobacterial species. PCR Thiamet G probes can rapidly detect resistance to rifampicin. These results can help decisions about treatment and infection control measures. All patients with TB, regardless of HIV status, must be notified. All potentially infectious patients should be managed in appropriate isolation facilities, such as negative pressure rooms,

with staff and visitors wearing high-efficiency particulate filtration masks. Complex drug interactions occur between rifamycins and antiretroviral drugs and other drugs that may affect dosages and dosing frequencies. The decision on whether to commence HAART in patients on anti-tuberculosis medication or not should take into consideration primarily the CD4 cell count; HAART should be strongly considered if the CD4 count is <100 cells/μL. Other factors such as adherence, potential toxicities and drug–drug interactions are also important. IGRA tests are preferred to TSTs (e.g. Mantoux). Chemo-preventative therapy should be considered for all IGRA-positive HIV-infected patients dependent on a risk assessment based on country of origin, blood CD4 cell count and length of time on HAART. Group chair and lead: Dr.