DOT is regarded

as the gold standard for delivering TB tr

DOT is regarded

as the gold standard for delivering TB treatment, but it may not be possible to deliver all elements of the DOT package. Witnessed buy Vincristine supervision of treatment may be impracticable and it is important to remember that patient-centred management is the cornerstone of treatment success. We recommend that DOT be used in all cases of MDR-TB. Patients with TB, with or without HIV infection, who are failing treatment or who relapse despite therapy pose particular management problems and should be referred to clinical colleagues who have expertise in the management of relapse and treatment failure, especially if taking HAART concomitantly. Every hospital/trust should have a policy for the control and prevention of TB. Specific consideration should be given to prevention of transmission of TB to and from immunosuppressed patients. Further guidance is contained in [4]. Worldwide, it is estimated that 14.8% of all new TB cases in adults are attributable to HIV infection. This proportion is much greater in Africa, where 79% of all TB/HIV coinfections are found. In 2007, 456 000 people globally died of HIV-associated TB [5]. All patients with TB, regardless of their perceived risk of HIV Alisertib supplier infection, should be offered an HIV test. In the United Kingdom,

an increasing number of patients with TB are coinfected with HIV. In 2003, 8.3% of adults with TB were HIV coinfected [6]. The proportion is higher in London, with coinfection rates of 17–25% [7]. In HIV coinfection the clinical and radiographic presentation of TB may be atypical. Compared with the immune-competent population, TB/HIV-infected patients with active pulmonary TB are more MYO10 likely to have normal chest radiographs or to have sputum that is smear negative but culture positive [8–10]. The clinician caring for HIV-infected patients therefore needs to have a high index of suspicion for TB in symptomatic individuals, especially those born abroad. As the investigation and treatment of both TB and HIV infection require specialist knowledge, it is mandatory to involve specialists in HIV, respiratory and/or infectious

diseases. These guidelines update the BHIVA guidelines from 2005 and are designed to provide a clinical framework applicable to adults in the UK coinfected with HIV and TB. These guidelines do not cover children. They do not provide advice on HIV testing in adults with newly diagnosed TB. They are based on the evidence available, but some recommendations have to rely on expert opinion until further data are published. These guidelines should be used in conjunction with: NICE: Tuberculosis: Clinical diagnosis and management of TB, and measures for its prevention and control, 2006 [1]. Treatment of TB benefits the individual and also the community. The aim of treatment is: to cure the patient of TB; The quality of any investigation is related to the quality of the specimen and the clinical detail provided within the request.

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