5.3.1 People with HIV

The 9-month all-oral MDR/RR-TB regimen was evaluated in a setting with a high HIV prevalence. In the dataset analysed for the 2022 WHO guidelines, over 70% of patients starting a shorter regimen were also living with HIV, and among those, more than 90% were receiving ART. There is no reason to believe that a 9-month all-oral regimen would perform any differently in People with HIV who initiate ART early, in accordance with WHO recommendations. However, clinicians should be mindful of the overlapping, additive toxicities and potential drug–drug interactions with antiretroviral medicines and TB drugs. Co-administration of zidovudine and linezolid should be avoided because of the increased risk of myelosuppression. Boosted protease inhibitors can increase bedaquiline exposure, thereby increasing the risk of bedaquiline-related adverse drug reactions (e.g. QT interval prolongation), which may require closer monitoring. Efavirenz can reduce the concentration of bedaquiline; therefore, this antiretroviral drug should be avoided in patients receiving the 9-month all-oral regimen. There are no overlapping toxicities or drug–drug interactions with dolutegravir in patients receiving the shorter regimen with either linezolid or ethionamide. People with HIV receiving the 9-month all-oral bedaquiline-containing regimen will need prophylactic medication for opportunistic infections, support for adherence to TB and antiretroviral medication, and close monitoring of the biomarkers of immune status.

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