Use of M/XDR-TB Regimen in People Living with HIV [PLHIV] ​

The shorter or longer oral Multi/ Extremely Drug-resistant TB (M/XDR-TB) regimens can be used in People Living with Human Immunodeficiency Virus (PLHIV), including those who are receiving Anti-retroviral Treatment (ART). 

The presentation of Multidrug-resistant (MDR)/ Rifampicin-resistant TB (RR-TB) in people living with HIV does not differ from that of Drug-sensitive TB (DR-TB).​ 

There are some basic points that must be covered in the management of DR-TB in PLHIV as follows:

1. Early diagnosis of DR-TB and HIV
2. Prompt initiation of appropriate second-line anti-TB drugs and ART
3. Sound patient support 
4. Airborne Infection Control (AIC) measures 

Close monitoring of people on the two regimens is advised.​​

In PLHIV with pulmonary MDR/RR-TB, additive toxicities or drug-drug interactions between anti-TB and ART medicines potentially overlap, e.g., Moxifloxacin (Mfx) and Clofazimine (Cfz) or Efavirenz, and Bedaquiline (Bdq) and Ritonavir may potentially increase the risk of Bdq-related adverse events and hence, combined use should be avoided or used with caution.​

Resources​

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• WHO Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
• Technical and Operational Guidelines for TB in India, 2016. 
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.

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