MMWR: HIV, TB & IGRA

Interesting interpretation of new CDC guidelines for HIV.

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Early Anti-HIV Therapy Shows Benefit in Opportunistic Infections

By Michael Smith, North American Correspondent, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.


ATLANTA, March 25 -- For treatment-naive HIV patients with an opportunistic infection, the benefits of immediate antiretroviral therapy outweigh the risks, according to new guidelines from the CDC.

Evidence is mounting that for most such infections -- especially if there is no specific treatment -- early antiretroviral therapy will contribute to faster resolution, the agency said in an early release of Morbidity and Mortality Weekly Report.

The report contains revised guidelines -- developed with the NIH and the Infectious Diseases Society of America -- for prevention and treatment of opportunistic infections in adults and adolescents with HIV.

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The guidelines note that all HIV patients should be tested for latent TB infection, either with the traditional tuberculin skin test or the new interferon-gamma release assay.

There is evidence, the guidelines say, that compared with the skin test the new test -- three are approved in the U.S. -- is more consistent and has higher specificity, is better correlated with surrogate measures of exposure to M. tuberculosis, and has less cross reactivity because of Bacillus Calmette-Guérin vaccination or other nontuberculous mycobacteria exposure.

Nevertheless, the skin test can be used where resources are limited, the guidelines say.

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