Emerging treatments

Disseminated Mycobacterium avium complex

Ethionamide, thiacetazone (not available in the most countries) and cycloserine have been combined with first-line agents as salvage regimens and may have activity. However, their role in this setting is not well defined, and are associated with substantial toxicities.[234] Although under investigation, due to insufficient data no recommendation can be made for the use of immunomodulators as adjunctive therapy.[1]

Cryptococcal meningitis

There are few data regarding the use of newer triazoles, such as voriconazole and posaconazole, as either primary or follow-up therapy for patients with cryptococcosis. Voriconazole should be used cautiously with protease inhibitors and efavirenz.[1][235]​ In HIV-associated cryptococcal meningitis, the addition of a short course of interferon gamma to standard treatment significantly increased the rate of clearance of cryptococcus from the cerebrospinal fluid without an increase in adverse events, yet further definitive clinical studies are needed.[236]

Cytomegalovirus (CMV)

Letermovir is a CMV viral terminase complex inhibitor that has been approved by the US Food and Drug Administration for CMV prophylaxis in high-risk haematopoietic stem cell transplant patients. Its role in the treatment of CMV retinitis is unclear and it can significantly interact with several antiretroviral agents.[237]​ Maribavir is a CMV viral kinase UL97 inhibitor that has been studied in transplant patients but data on its use for CMV disease in patients with HIV are lacking.

Tuberculosis (TB)

A regimen of 1 month of daily isoniazid plus rifapentine has been evaluated in a randomised, open-label, phase 3 trial and found to be non-inferior to 9 months of isoniazid alone for preventing TB in patients with HIV who were living in areas of high TB prevalence or who had evidence of LTBI.[238] US guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV include the 1-month regimen as an alternative option for treatment of LTBI in people with HIV.[1] However, it is not currently recommended in the National Tuberculosis Controllers Association and Centers for Disease Control and Prevention guidelines.[65]

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