Management of advanced HIV disease in patients with tuberculosis or hepatitis co-infection.
Advanced human immunodeficiency virus (HIV) disease can be defined as a cluster of differentiation 4 (CD4) count <50 cells/mm(3) or the presence of an acquired immunodeficiency syndrome (AIDS)-defining illness. In the UK and Ireland, the number of patients who present with advanced HIV disease is increasing, with 301/977 (31%) of patients presenting late (<200 CD4 cells/mm(3)). Many patients who present with advanced HIV disease will have comorbid conditions, such as hepatitis B or C or tuberculosis (TB), which complicates the choice of therapy. This article reviews the evidence and some clinical scenarios for specific patient groups who may present with advanced HIV disease: those with comorbid TB, hepatitis B or hepatitis C. The aim is to offer practical advice on therapeutic options for treatment-naïve patients who present with advanced HIV disease on the basis of available clinical evidence.
Nelson
M
M
St Stephen's Centre, Chelsea and Westminster Hospital, London, UK. mark.nelson@chelwest.nhs.uk
Lipman
M
M
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004347:Drug Interactions; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D014376:Tuberculosis / Q000150:complications*