Sample Review of TB and HIV treatment in Thailand

1. Simple Review treatment of
TB and HIV
Thai Regimens
Sathienwit Rowsathien, MD.

2. TB
• Directly Observed Therapy (DOT) is key…
– Self-administered is not DOT!
• Only single dose per day
– TB replication times is over 24 hrs period.

3. TB Catergory
• CAT I
– Newly diagnose patient with TB smear +ve
– Seriously ill with extra pulmolnary TB, Parenchymal TB
– 2HRZE:4HR
• If smear +ve at 2 month, add 1HRZE (total 3HRZE) and repeat smear at
3 month + DST
• 7HR if smear +ve at 3 month, meningitis, disseminated or spinal bone
or joint complication.
• CAT II
– Relapse, Failure, After default
– 2HRZES:1HRZE:5HRE
• If smear +ve at 3 month, add 1HRZES (total 4HRZES) and repeat smear
at 4 month + DST

4. TB Catergory
• CAT III
– TB smear –ve (thx 3 times )
– Minor extra pulmonary TB (TB lymphadenitis)
• 2HRZ:4HR
• CAT IV
– Chronic TB
• Combination of reserved drugs.
• Consult ID specialists
• May classified as MDR:TB, XDR:TB :(
• 6 months initiation, 18 months continuation phase.

5. TB Drugs in Thailand (combine)
• RIMSTAR/RIFAFOUR per 1 tablet
– H 75 mg (I)
– R 150 mg
– Z 400 mg
– E 275 mg
• RIMACTAZID per 1 tablet
– H 75 mg (I)
– R 150 mg
• RIFINAH 150/300
– H (100) R (150)
– H (150) R (300)

6. TB Drugs
S may be no more than 750mg/day in old age (60+)

7. TB Drugs

8. HIV
• HAART when CD4 <350
– 2NRTI+1NNRTI, or 2NRTI+1PI
• If TB coexists
– CD4 <350 start HAART within 2 weeks after start Anti-TB
– CD4 >350, wait for cure TB 
– Common Regimen as 3TC+d4T+NVP or 3TC+AZT+NVP
• Start Anti-TB as CAT I is appropriated.
– If HAART include Efavirenz or 2nd line drugs, consult ID first.

9. HIV

10. HIV Thai regimen
• Usually initiate with 3TC+AZT+NVP (AZT long
term SE less than d4T) except
– Severe anemia (Hb<8.4)
– CD4 > 100
– Low BW
• May initiate with GPOVir S30 (d4T) but no more than 6
month then switch to GPOVirZ (AZT) (and viral load
must <50copies/ml)

11. HIV Thai regimen
• Lead in NVP in 1st 2 weeks (Prevention SJS)
– NVP(200) 1 dose per day in 1st 2 weeks
– Ex. GPOVirZ 1 tab in the morning, 3TC+AZT (Zilarvir no
NVP) before bedtime.
• If no SJS, no hepatitis (liver enzyme not exceed more
than 5x base line) , continue NVP full dose
– (NVP(200) 1 tab o q 12 hr), GPOs30 or GPOvirZ 250 BID

12. HIV Thai regimen
• EFV-based regimen
– For NVP Failure
– EFV OD HS, 3TC+AZT (or D4T) q 12 hr
– Common SE is insomnia, nightmare (improve
within 2 weeks after initiate)

13. HIV Thai regimen
• PI-based regimen
– Poor tolerance in NNRTI based regimen
– d4T + 3TC + IDV + RTV (all bid)
• IDV  SE: non opaque stone, pt. must drink 1.5-2 L of
water/day

14. Common NRTI SE
• d4T
– Peripheral neuropathy
– Hyperlactatemia (beware of high gap acidosis)
– Lipodystrophy
– Dyslipidemia
• AZT
– BM suppression
– GI irritation
– Headache and myopathy

15. Common NRTI SE
• ddI
– GI irritation
– Pancreatitis
– Peripheral neuropathy (in comb with d4T)
• 3TC
– Low SE

16. Common NNRTI SE
• NVP
– SJS
– Hepatitis
• EFV
– Neuropathy
– Dyslipidemia

17. Common PI SE
• IDV
– Decrease GFR
– Non opaque stone

18. HAART Failure
• Virological failure
– Viral load > 1,000 copies/ml in 6 month after initiation of
HAART
• Immunological failure
– CD4 increase <50 cells/mm3 in 1st year
– CD4 decrease after peak more than 30%
• Clinical failure
– OI (except TB)

19. References
• CDC
• WHO
•
•
• KKU
• Google 