COINFECÇÃO TUBERCULOSE E HIV E INTERAÇÕES MEDICAMENTOSAS

otimização da terapia antirretroviral simultânea e manejo da Síndrome da Reconstituição Imune (IRIS)

Abstract

Tuberculosis-HIV coinfection remains a major clinical and public health challenge, particularly in low- and middle-income countries. In Brazil, the increasing proportion of tuberculosis cases among people living with HIV (PLHIV), combined with persistent late HIV diagnosis and social inequalities, highlights the need for integrated models of care. This article reviews epidemiological, immunopathogenic, diagnostic, and therapeutic aspects of HIV-TB coinfection, with emphasis on drug-drug interactions between antiretroviral and anti-tuberculosis therapies, the management of immune reconstitution inflammatory syndrome (IRIS), and public health policies implemented within the Brazilian Unified Health System (Sistema Único de Saúde – SUS). Recent advances are discussed, including the incorporation of rapid molecular testing for tuberculosis (Xpert MTB/RIF), the LF-LAM urine assay for individuals with advanced immunosuppression, expanded access to dolutegravir (DTG), and implementation of tuberculosis preventive therapy with rifapentine and isoniazid (3HP). The article highlights the central role of SUS in technological incorporation, decentralization of healthcare delivery, and integration between primary care and specialized services. Persistent challenges related to drug toxicity, pharmacological interactions, multidrug-resistant tuberculosis, and barriers to treatment adherence and retention in care are also addressed. Furthermore, the review emphasizes that controlling tuberculosis and HIV-TB coinfection requires intersectoral strategies aimed at addressing social determinants of health, including social protection policies, food security initiatives, and transportation support, which are essential to strengthen the continuum of care and improve health outcomes among socially vulnerable populations.