Diagnosis and Management of Drug-Resistant TB with HIV Co-Infection

Diagnosis and Management of Drug-Resistant TB with HIV Co-Infection


A 46-year old male attends a primary health care clinic with cough, fever, night sweats, weight loss, chest pain and anorexia. He reports a history of a previous episode of smear-negative pulmonary tuberculosis two years previously, for which he completed six months of a standard treatment regimen (2HRZE/4HR). He discloses that he is HIV infected but he has not previously accessed HIV care or CD4+ cell count testing. He had been working in the gold mines in Gauteng province until a few months before presentation. 

A sputum specimen is submitted for Xpert MTB/RIF testing and blood taken for CD4+ cell count measurement. 

The Xpert MTB/RIF is reported as M. tuberculosis detected and rifampicin resistance detected. CD4+ cell count is 205 cells/µL. 

Question 1: What is the most appropriate course of action to take?


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