Clinical Manual for Management of the HIV-Infected ... - myCME.com

Patient Education
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Patients should know that although they have the
TB germ in their bodies, they cannot pass the germ
to others while TB is latent. However, because they
have HIV infection, the TB germ is more likely to
make them sick at some point in the future.
The medicine patients are starting will help kill the
TB germ and reduce their chances of getting sick
with active TB.
Patients must take all of their medicine, every day,
to prevent the TB germ from spreading and making
them sick.
If patients have adverse effects, such as rash or
itching, tell them to contact their health care
providers immediately. Occasionally, INH can cause
tingling or numbness in the hands or feet. The
pyridoxine (vitamin B6) they are taking should help
prevent that, but they should let their providers know
if it occurs.
Patients should avoid alcohol while taking these
medications. The medicines for TB are processed
by the liver and, when combined with alcohol,
they easily can overload the liver. Acetaminophen
(Tylenol) also is processed by the liver, so patients
should keep their intake to a minimum. (Patients
with hepatitis C, liver disease, or chronic alcohol use
should not take more than 3.5 grams per day.)
Blood tests will be done regularly to make sure the
liver is working well, so it is important for patients to
keep their follow-up appointments. They should take
all their medications, vitamins, and supplements with
them to the clinic so that their health care providers
can review them and make sure there are no drug
interactions.
If patients experience nausea, vomiting, poor
appetite, or abdominal pain, if they notice their urine
darkening or becoming cola-colored, or if they notice
their eyes or skin yellowing, they should return to the
clinic immediately. These problems may indicate that
the liver is being overwhelmed, and it is important to
find out before permanent damage is done.
Rifampin will cause sweat, tears, urine, and plastic
contact lenses to turn orange.
Rifampin will make birth control pills ineffective.
Patients should use a backup method of
contraception until treatment is complete. Condoms
can help prevent HIV transmission and reduce the
risk of pregnancy.
Section 2—Health Maintenance and Disease Prevention | 2–43
References
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American Thoracic Society. Targeted tuberculin testing
and treatment of latent tuberculosis infection. MMWR
Recomm Rep. 2000 Jun 9;49(RR-6):1-51.
Blumberg HM, Leonard MK, Jasmer RM. Update
on the treatment of tuberculosis and latent tuberculosis
infection. JAMA. 2005 Jun 8;293(22):2776-84.
Bucher HC, Griffith LE, Guyatt GH, et al. Isoniazid
prophylaxis for tuberculosis in HIV infection: a metaanalysis
of randomized controlled trials. AIDS. 1999
Mar 11;13(4):501-7.
Centers for Disease Control and Prevention,
American Thoracic Society. Update: adverse event
data and revised American Thoracic Society/CDC
recommendations against the use of rifampin and
pyrazinamide for treatment of latent tuberculosis
infection—United States, 2003. MMWR Morb
Mortal Wkly Rep. 2003 Aug 8;52(31):735-9.
Leinhardt C, Fielding K, Sillah J, et al. Risk factors for
tuberculosis infection in sub-Saharan Africa: a contact
study in The Gambia. Am J Respir Crit Care Med.
2003 Aug 15;168(4):448-55.
Quigley MA, Mwinga A, Hosp M, et al. Long-term
effect of preventive therapy for tuberculosis in a cohort
of HIV-infected Zambian adults. AIDS. 2001 Jan
26;15(2):215-22.
U.S. Department of Health and Human Services.
Guidelines for the Use of Antiretroviral Agents in HIV-
1-Infected Adults and Adolescents. October 10, 2006.
Available online at aidsinfo.nih.gov/Guidelines/
GuidelineDetail.aspx?GuidelineID=7. Accessed July
7, 2007.
U.S. Public Health Service, Infectious Diseases
Society of America. Guidelines for preventing
opportunistic infections among HIV-infected persons
— 2002. MMWR Recomm Rep. 2002 Jun
14;51(RR08);1-46. Available online at aidsinfo.nih.
gov/Guidelines/. Accessed May 19, 2006.