TB & HIV

[PozBrian]

I'm not sure if this topic belongs here or in the "I just tested positive" forum but since my question deals primarily with meds I figured this was the best place.

I tested positive on 4/10/09 by 4/21, I had the my first set of blood test done with a CD4 of 296 (18%) and a VL of 115000. I also had a TB skin test that reacted. BTW wouldn't it be easier to take a whole pint of blood rather than about 20 vials? I went to the ID clinic several times that week and got blood drawn each time!

Anyway, back to the TB. Apparently the size of the reaction that is required for a reactive TB test is smaller for someone who is HIV+ than HIV-. I didn't think anything about it at first. Chest x-ray is clear so it is not active but is latent TB and not contagious. Only bit of good news I had the whole week.

Long way to get to the questions but my doctor is talking about INH and Atripla. Starting one and then the other to be able to better distinguish which med may be causing any side affects. INH has some pretty serious effects for the liver, and the Sustiva portion of Atripla seems, from what I have read, can impact the liver too. Does anyone have any experience with INH and Atripla? How long should I wait before starting the second med (doc is saying 6-8wks). Would it be better to start INH first and deal with the TB or to start Atripla and improve my CD4 and VL load number to reduce the risk of the TB going active?
Thanks

[aztecan]

Hey Brian,

You are correct. A TB reaction in someone who is HIV poz need be only half the size of a reaction in someone who is negative.

That said, I think your doctor has the right idea. Of those who I have known who have been in a similar situation, they first started the INH. I wouldn't worry about either the INH or Atripla being hard on your liver at this time.

You would only be on INH for six or nine months. Most HIV docs opt for nine these days, but that can vary.

While the nuke component of Atripla is the usual culprit regarding liver issues, they are not all that common with either Emtriva or Tenofovir, the two nukes found in Atripla, so I wouldn't worry about liver complications until they show up.

Since your doctor should be monitoring you closely. this shouldn't be a problem.

It sounds like your doctor knows what he/she is doing.

Let us know how you fare with INH.

HUGS,

Mark

[PozBrian]

Thanks, I'm beginning to come to the conclusion to start with the INH, although my blood numbers worry me a bit. I've done a lot of reading about TB and HIV and it is a pretty big deal outside the US and Europe where TB is more prevalent.

There's really no telling where or when I may have picked up the TB, not that it matters. I remember being notified when I was in college, 25 years or so ago, that a coworker from a summer job had TB. I got a PPD then but did not react. While I was in the Navy I went to all kinds of places where I might have picked it up and never noticed.

The risk of latent TB becoming active TB moves from 5-10% in a lifetime to 5-10% per year when co-infected with HIV. Quite an increase. Add to that the ease infecting others with TB vs. HIV and I think starting INH first is probably the right decision.

9 months and no alcohol. Gonna miss my brewskis.

[aztecan]

Hang in there. I'm sure you will do fine.

HUGS,

Mark

[LordBerners]

I had TB last year, and doctors here seemed to consider the 'reaction test' not particularly useful as they said that a huge percentage of the population here in Thailand has 'been exposed to' TB.  It took months of guesswork before I was finally correctly diagnosed, and by that time I had lost about 25% of my body weight and was a very sick person.

I was put on not just INH but the full regime of anti-TB drugs - if I remember rightly it was rifampin or something in that family, isonazid, ethambutol, and pyrazinamide.  These worked well - in a matter of days I felt worlds better, and was back to normal in a few weeks.  I took the meds for 6 months and so far there has been no remission.   

Unfortunately for me the big issue was ARV resistance - I was placed on Sustiva and Truvada midway through my TB treatment, and the docs prescribed the regular 600 mg does of sustiva.. aparently the rifampin reduces the effective dose of sustiva, and increasing the dose to 800 mg is normal practice.  Personally if I had it to do over again I would have simply delayed beginning ARV untill after completing the TB meds course - it isn't as if there was anything urgent about it. 

So, the upshot was I am now resistant to efavirenz (sustiva) and several other meds, in spite of pretty good adherence (never missed a dose, and only a few hours off a few times).  So be careful.

[joemutt]

Just found out I have latent TB but lungs clear and CD4s ca 950 for the last 10 + years.
I eat well and exercise 3+ times a week. I declined the INH course because of generally good health but
weak liver (ARVs), the ID dr agreed after some talk, she s latent herself (but hiv -) and neither her nor her tb latent + colleagues took the INH or other tb meds. Has anyone experience with this particulars? Thanks.

[aztecan]

The only experience I have was vicariously through someone I know. This guy went years with latent TB, gratefully never becoming active.

But, it did have the long-term effect of causing damage in his lymph glands. He wound up having necrotic (dead) tissue there. He was eventually treated and is doing well.

As PozBrian said, the chance of TB becoming active is much greater in a positive person, so keep an eye on it. If I were you, I would ask for annual chest X rays just to be sure.

Here in the states, they tend to treat TB more aggressively.

HUGS,

Mark

[positivmat]

I was diagnosed with latent TB as well.  My grandmother had it and all of her children and grandchildren test positive for it.  My doc put me on atripla first and will "treat" the TB starting this summer.  My understanding was that he wanted my tcells to go up from their initial 325 and 13% after particularly bad ARS.  That seemed logical to me, but the information you post concerns me.  Would not like to lose atripla as my regimen.
Matt