Margherita Bracchi

Issues in the care of people living with HIV and TB were covered, including latent TB treatment, risk factors for recurrent TB, diagnostics (drug sensitivity testing and the novel molecular assays, XpertUltra), dolutegravir safety and efficacy in patients on TB treatment, and clinical outcomes on the novel TB drug, bedaquiline.

Dr Mugomeri reported that isoniazid preventive therapy (IPT) was effective when given within 1 year of commencing ART in Lesotho, with efficacy declining after 4 years, highlighting the potential need for IPT-booster doses. A study by IeDEA of 634 TB patients (272 HIV-positive) highlighted how discrepancies in drug-susceptibility testing are associated with higher mortality in drug-resistant TB, mainly due to patients being undertreated. Xpert Ultra for the diagnosis of TB meningitis in a Ugandan study reported by Dr Cresswell showed a striking diagnostic sensitivity of~90% in the cerebrospinal fluid, representing a game-changer in this extremely challenging disease; however it should not be used as single rule-out test. A retrospective cohort analysis of MDR-TB patients in South Africa showed that those switched to bedaquiline when experiencing side-effects on second-line injectables(SLIs) had improved outcomes compared to those remaining on SLIs at 12 months, with more sustained culture conversion

The 48 weeks results of INSPIRING trial confirmed that dolutegravir 50mg twice-daily can be effectively and safely used in TB/HIV co-infected adults, supporting use of this dose in clinical settings. HIV was the strongest risk factor for TB recurrence in Cape Town, but not an independent risk for TB-mortality. ART showed protection against the first episode of recurrence. Based on the Lesotho study, early IPT after ART-commencement and booster doses are needed for prolonged protection against TB, however the study enrolled a diverse population, which could confound results; a need for improvement in TB diagnosis prior to IPT was highlighted.