title: Management of drug resistantTB in patients with HIV co-infection.
abstract: BACKGROUND
  Multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB) are major public health concerns worldwide. Their association with HIV/AIDS infection has contributed to the slowing down of TB incidence decline over the last two decades, therefore representing one of the most important barriers to reach TB elimination.
  
  
  METHODS
  The aim of this manuscript is to critically review the recent scientific evidence on the management of drug-resistant TB (essentially MDR- and XDR-TB) in subjects coinfected with HIV, focusing on the two new recently-approved anti-TB drugs delamanid and bedaquiline. The medical search-engine PubMed was used, selecting the time-period January 2013 - February 2015, and using the following
  
  
  BACKGROUND
  drug-resistant TB, multidrug resistant TB (or MDR-TB), extensively drug-resistant TB (or XDR-TB), delamanid and bedaquiline.
  
  
  CONCLUSIONS
  The TB/HIV co-epidemic can be faced by implementing the 12 TB/HIV collaborative activities recommended by the World Health Organization. They are focused on the systematic screening of individuals to detect the Mycobacterium tuberculosis infection in HIV-positives, as well as HIV infection in TB patients in order to ensure a rapid initiation of the anti-retroviral therapy (ART). The clinical and public health management of HIV-positive individuals with MDR-TB is complex and expensive, given the cost of second line anti-TB drugs (including the new drugs, delamanid and bedaquiline) and ART. Political commitment and more investment to identify shorter, cheaper and effective anti-TB and HIV regimens as well as better diagnostics and, hopefully, a vaccine will contribute to boost the efforts to eliminate TB.
authors.affiliation: a Department of Infectious Diseases , Galliera Hospital, Mura delle Cappuccina, 14 , 16128 Genova , Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pontali
authors.affiliation: b Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences , University of Sassari - Research, Medical Education and Professional Development Unit, AOU Sassari, via Padre Manzella, 4 , 07100 , Sassari , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.affiliation: c WHO Collaborating Centre for TB and Lung Diseases , Fondazione S. Maugeri, Care and Research Institute , via Roncaccio 16, 21049 Tradate , Italy.
authors.forename: Rosella
authors.initials: R
authors.lastname: Centis
authors.affiliation: c WHO Collaborating Centre for TB and Lung Diseases , Fondazione S. Maugeri, Care and Research Institute , via Roncaccio 16, 21049 Tradate , Italy.
authors.forename: Lia
authors.initials: L
authors.lastname: D'Ambrosio
authors.affiliation: d Pneumology Unit , Fondazione Maugeri, IRCCS , via Roncaccio 16, 21049 Tradate , Italy.|e Department of Clinical and Experimental Medicine , University of Insubria , via Guicciardini 9, 21100 Varese , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spanevello
authors.affiliation: c WHO Collaborating Centre for TB and Lung Diseases , Fondazione S. Maugeri, Care and Research Institute , via Roncaccio 16, 21049 Tradate , Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection; D064687:Diarylquinolines / Q000627:therapeutic use; D019468:Disease Management; D054908:Extensively Drug-Resistant Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009593:Nitroimidazoles / Q000627:therapeutic use; D010080:Oxazoles / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D064687:Diarylquinolines; D009593:Nitroimidazoles; C516022:OPC-67683; D010080:Oxazoles; C493870:bedaquiline
keywords: HIV; MDR-TB; XDR-TB; bedaquiline; delamanid; prevention; tuberculosis