A placebo-controlled study comparing the effect of steroids with that of placebo in early IRIS showed a benefit of steroids, but the data have to be interpreted with caution as a substantive proportion of the placebo arm were treated with open-label prednisolone [182]. Recurrent needle aspiration of nodes or

abscesses is appropriate if they become tense and/or inflamed. This can prevent spontaneous rupture which may lead to long-term sinus formation and scarring. Other GW-572016 research buy treatments have as yet little evidence supporting their use. Nonsteroidal anti-inflammatory agents are generally not helpful. Temporary discontinuation of antiretroviral therapy has also been advocated but can cause precipitous falls in CD4 cell counts. Leukotriene overactivity has been implicated in IRIS, and montelukast can be considered as an alternative to steroids, but may need to be continued for a long period [183]. [DII] The efficacies of other therapies such as interleukin-2, granulocyte–macrophage colony-stimulating factor and hydroxychloroquine are as yet unproven. There is one case report of the resolution of IRIS in an HIV-negative patient with the use of infliximab [184]. [DIII] There have been no randomized

click here controlled trials or systematic reviews examining the use of DOT in TB/HIV coinfection. However, the use of DOT is seen as the gold standard by WHO and CDC for the treatment of HIV-related TB, especially when using intermittent dosing. It is recommended by NICE for those deemed likely to have poor adherence, including those who are street- or shelter-dwelling

homeless [1]. To help prevent the emergence of resistance, combination tablets (e.g. Rifater, which includes rifampicin, isoniazid and pyrazinamide) should be used whenever practicable. It is recommended that all patients with MDR-TB have DOT. [AII] Patient-centred care should be at the core of multidisciplinary management and should always include an adherence strategy. This may include DOT/supervised therapy for HAART [185]. [BIII] However, there are no published data on the utility and efficacy of combined HAART/TB DOT in treating HIV/TB coinfection. DOT usually requires that patients isothipendyl be observed to ingest each dose of anti-tuberculosis medication. Any treatment plan should be individualized to incorporate measures that facilitate adherence. These may include social service support, treatment incentives, housing assistance, referral for treatment of substance misuse, and co-ordination of TB services with those of other providers. There are many patients taking both HIV and TB therapies concomitantly. A maximum adherence model which is patient-centred, and utilizes family and friends and other social support as well as healthcare workers to ensure adherence, is an approach being examined more closely.