**9. Conclusion**

The failure of the antituberculous/antiretroviral treatment is generally a result of the low compliance, inadequate treatment regimen (length, doses, low penetration into the CSF, adverse reactions impeding the use of certain efficacious drugs), delays in the diagnosis or treatment resistance. Any changes in the clinical examination, imaging studies and CSF aspect during treatment or at follow-up require further investigations. Despite the immunodeficiency the prognosis of CNS TB in HIV patients resembles that of non-HIV patients.


**•** Drug interactions and toxicities (see table 3). The clinician should recognize the overlapping toxicities, drug interactions and also the occurrence of IRIS (paradoxical reactions) [133].The interactions between NNRTI or NRTI and antituberculous drugs are few. The risk of toxicity is minimal but adverse reactions are possible with some NRTIs (see table 3). Regarding the toxicity the ARV could interfere not only with antituberculous drugs but also with other drugs used in the prophylaxis or treatment of other opportunistic infections (such as fluconazol for Candida or Criptococcus neoformans or sulphametoxazole/trimethoprim for

**•** The efficiency and complications of treatment. The efficiency is to be monitored on a clinical, virologic and immunological basis. The best control in HIV infections is the virologic (RNA HIV viral load) and immunologic control (CD4+ cell count).Treatment control could be undertaken at 14 days, one month, three and six months respectively. If the HIV RNA load does not become undetectable after 3 months of treatment virologic failure should be considered. If this is the case investigations on the underlying cause should focus on the lack of adherence, acquired resistance (especially to NNRTIs) or a wrong treatment regimen (doses, antagonistic associations or the lack of drug penetration to the CSF). Nevertheless the intracerebral load of HIV could be hard to evaluate since the viral load detection in the

**•** Drug resistance. In case of virologic failure drug-resistance testing should be obtained during treatment with the failing ARV regimen or within 4 weeks of treatment discontinu‐ ation. Resistance to antiretrovirals generally applies to most compounds in the same class.A new regimen with other fully active drugs preferably from other new classes must be

**3.** *Individualized treatment*: the treatment options should address other opportunistic infections and the patient's medical history. A CD4+ count under 200 cells/mm3

The failure of the antituberculous/antiretroviral treatment is generally a result of the low compliance, inadequate treatment regimen (length, doses, low penetration into the CSF, adverse reactions impeding the use of certain efficacious drugs), delays in the diagnosis or treatment resistance. Any changes in the clinical examination, imaging studies and CSF aspect during treatment or at follow-up require further investigations. Despite the immunodeficiency

the prognosis of CNS TB in HIV patients resembles that of non-HIV patients.

prophylaxis against fungal infections (cryptococcus, pneumocytsis). Prophylaxis against toxoplasmosis should be started at a CD4+ cell count under 100 cells/mm3 due to an increased risk of reactivation. Pregnant patients require urgent ARV treatment after 14

urges the

serum does not always reflect the intracerebral levels of HIV.

Penumocystis jirovecii).

314 Tuberculosis - Current Issues in Diagnosis and Management

restarted.

**9. Conclusion**

days of antituberculous treatment.


**Acknowledgements**

tions and their interpretation.

**Author details**

**References**

Simona Alexandra Iacob1

The authors wish to express special thanks to professor Ionescu Virgil for the MRI reproduc‐

Neurotuberculosis and HIV Infection http://dx.doi.org/10.5772/54631 317

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\*\*\*very good ability to cross the blood-brain barrier; \*\* moderate ability to cross the blood-brain barrier; \* low ability to cross the blood-brain barrier

**Table 3.** The most important antituberculous and antiretroviral drugs used in the treatment of CNS tuberculosis [113-118]
