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Tuberculosis – When to Refer

When to Refer

PLWHIV Already Receiving ART

  • For PLWHIV who are receiving ART that is not recommended for concomitant use with anti-TB medication, specialist HIV treatment advice should be sought.1

Resistance or Intolerance to Recommended Regimens

  • If resistance or intolerance preclude use of recommended ARV regimens or suggested alternatives for antiretroviral-naïve patients, seek expert advice.1

– see EACS Guidelines for Recommended Regimens

TB Treatment Failure

  • TB treatment failure is defined as continued or recurrently positive cultures during the course of anti-TB therapy. Patients whose sputum cultures remain positive after 4 months of anti-TB treatment should be considered treatment failures.2

– all treatment failure cases should be referred to a regional centre2

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB)

  • All patients with TB strains resistant to at least isoniazid and rifampicin (MDR-TB) should be referred to regional treatment centres.2,3
  • Patients with XDR-TB (strains resistant to at least isoniazid plus rifampicin and to fluoroquinolones and at least one of capreomycin, kanamycin or amikacin) should also be referred to consultants with expertise in its management.2,3


  1. European AIDS Clinical Society. Guidelines Version 6.0. Accessed 17 April 2012.
  2. British HIV Association. Guidelines for the Treatment of TB/HIV Coinfection 2011.  Accessed 25 November 2011.
  3. World Health Organization. Treatment of Tuberculosis Guidelines Fourth Edition (2010)