Update on treatment and prevention guidelines for HIV-related tuberculosis.

A report published in October 1998 contains guidelines on managing HIV-related tuberculosis based on recommendations by two panels convened by the Centers for Disease Control and Prevention (CDC). The major topics include treatment options for active tuberculosis, drug interactions between rifamycins and antiretroviral drugs, and preventive therapy. HIV-infected patients should receive prompt treatment with a multidrug regimen, and should be evaluated for antiretroviral therapy (HAART). A decision tree of recommended management strategies is given. All HIV-positive patients with a positive tuberculin skin test should receive directly observed therapy (DOT). Drug interactions between rifamycins and protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) pose serious patient management problems. Dosing of HAART should be modified according to rifabutin levels.