All People with HIV with DS-TB may be treated using the same duration of TB treatment as HIV-negative TB patients. There is much experience of treating these patients with the 6-month rifampicin-containing regimen 2HRZE/4HR (1, 36). The 4-month regimen with rifapentine and moxifloxacin has also been shown to perform well in patients who are also HIV-positive (1). The evidence on the use of this 4-month regimen in People with HIV was limited to those with a CD4 count of above 100 cells/mm³ ; hence, the CD4 count value below 100 cells/mm³ is currently used in excluding People with HIV from the shorter regimen. For People with HIV with a CD4 count above that threshold, both regimens can be used.
CALHIV were eligible for enrolment in the SHINE trial. In view of the limited evidence available from the trial, clinicians may consider treating CALHIV with non-severe TB for 4 months with 2HRZE/2HR, depending on the degree of immunosuppression and ART status, as well as the presence of other opportunistic infections. These children and adolescents will need to be monitored closely, especially at 4 months of treatment.
As discussed above, all People with HIV (especially those with TB) should receive ART. People with HIV who are responding to ART should not expect a less favourable outcome to a treatment episode than those who are HIVnegative. Therefore, People with HIV with DS-TB can benefit from currently recommended treatment regimens. For further information, see WHO’s The use of antiretroviral drugs for treating and preventing HIV infection (23) and WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders (37).