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Neftaly Guidelines for the management of TB/HIV co-infection in adults
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It appears there isn’t a specific “Neftaly” policy or guideline for the management of TB/HIV co‑infection in adults. What you likely mean are the widely used South African clinical and HIV guidelines, particularly those developed by the South African National Department of Health (NDoH) and the Southern African HIV Clinicians Society (SAHCS).
Here’s a concise summary of the most up‑to‑date from those:
???? Key Components of TB/HIV Co‑infection Management in Adults (South African Context)
1. TB Screening & Diagnosis
- Symptom-based screening (cough, fever, weight loss, night sweats, TB contact). A positive screen → chest X‑ray, urine LAM, and sputum GeneXpert MTB/RIF regardless of symptoms or sputum production.Spotlight+9sahivsoc.org+9sahivsoc.org+9
- Urine LAM: particularly recommended for HIV-positive inpatients with CD4 ≤ 100 cells/μL or seriously ill patients (including outpatients), helps expedite diagnosis.sahivsoc.org+1NCBI+1
2. Timing of ART Initiation
- ART should be started promptly after TB diagnosis, typically within 2–8 weeks:
- Within 2 weeks for patients with CD4 < 50 cells/µL.
- Within 8 weeks for patients with higher CD4 counts.
- Exception: When TB meningitis is diagnosed, ART may need to be delayed to manage risk of IRIS.NCBI+1PMC+1
3. Antiretroviral Regimen Considerations
- Preferred first‑line regimen in co‑infected adults is dolutegravir (DTG)‑based (e.g. DTG + 3TC + TDF or TAF).Spotlight+8PMC+8Clinical Options+8
- Rifampicin interactions: Rifampicin lowers concentrations of many ART drugs via CYP450 induction.
- Current WHO guidance recommends doubling the DTG dose (from 50 mg once to 50 mg twice daily).
- However, recent trial data (e.g. RADIANT‑TB) suggests standard once‑daily DTG may suffice.Clinical Options+1Spotlight+1
- Bictegravir (BIC)/FTC/TAF given twice daily is emerging as an alternative for patients on rifampicin‑based TB treatment.Clinical Options
4. TB Preventive Therapy (TPT)
- Isoniazid preventive therapy (IPT) should be started as soon as active TB is excluded—regardless of tuberculin skin test or pregnancy (exceptions with CD4 < 350).
- Newer short-course regimens (e.g. 3HP—isoniazid + rifapentine once weekly for 3 months—or 1HP) are now supported by global evidence, and South African policy is in process to roll these out for high-risk PLHIV.
5. IRIS Management
- Prednisone prophylaxis (low‑dose) is recommended to reduce paradoxical TB‑IRIS when ART is initiated within the first month of TB treatment.
6. Co‑trimoxazole Prophylaxis (CTX)
- CTX prophylaxis should be provided to all HIV-positive TB patients until CD4 recovery or as per national protocol. It significantly reduces mortality and morbidity.
7. Monitoring & Adherence
- Frequent clinical follow‑up, viral load and CD4 where indicated.
- Adherence support is essential, particularly given the dual regimen burden (TB + ART).
- Training of nurses and community health workers in integrated adherence counselling is critical.
???? Quick Reference Table
| Area | Key Guideline Actions |
|---|---|
| Screening/Diagnosis | Symptom screen + GeneXpert + urine LAM |
| ART Timing | Start within 2–8 weeks; earlier if CD4 < 50 |
| ART Regimen Choices | DTG-based; adjust dose if on rifampicin; BIC/FTC/TAF option |
| TB Preventive Therapy | IPT or short-course (3HP/1HP) after excluding active TB |
| IRIS Prophylaxis | Low-dose prednisone if initiating ART within 1 month |
| CTX Prophylaxis | Standard for HIV/TB coinfection |
| Adherence & Support | Frequent monitoring and counselling |
Additional Guidelines
- Refer to
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