Bibliographic information
Recommendation
People living with HIV with TB and histoplasmosis coinfection should receive TB therapy according to WHO treatment guidelines
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
When histoplasmosis is not controlled because of interactions between rifampicin and itraconazole, clinicians may consider, depending on local context, extending the duration of amphotericin B induction therapy, once-weekly courses of amphotericin B, increasing the itraconazole dose and monitoring the blood level and toxicity and considering using other azole drugs (osaconazole, voriconazole, or fluconazole). Finally, clinicians can consider replacing rifampicin with rifabutin. Treatment may need to be revised for people experiencing toxicity, drug-drug interactions, or for those with resistance profiles requiring protease inhibitors or second-line TB drugs. When possible, antiretroviral resistance genotyping and TB drug susceptibility testing may assist clinical decisions. Itraconazole serum level testing may not be available in some areas.
Also Featured In
This recommendation also appears in the following guidelines:
Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach
WHO consolidated guidelines on tuberculosis: module 6: tuberculosis and comorbidities.
WHO guidelines on the management of advanced HIV disease