Question:
A patient with HIV is recently diagnosed with multidrug-resistant tuberculosis. What is the appropriate regimen, and what should the patient be monitored for?
A patient with HIV is recently diagnosed with multidrug-resistant tuberculosis. What is the appropriate regimen, and what should the patient be monitored for?
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MDR-TB regimen clue: BPaLM. HIV-TB treatment requires monitoring for IRIS.
Updated On: May 14, 2026
- BPaLM; monitor for immune reconstitution syndrome
- INH + Levofloxacin + Pyrazinamide + Ethambutol; monitor for hepatotoxicity
- INH + Levofloxacin + Streptomycin + Ethionamide; monitor for pyridoxine deficiency
- INH + Clarithromycin + Pyrazinamide + Ethambutol; monitor for optic neuritis
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The Correct Option is A
Solution and Explanation
Concept:
BPaLM is a regimen used for drug-resistant tuberculosis. In HIV patients starting or receiving ART along with anti-TB treatment, immune reconstitution inflammatory syndrome should be monitored.
Step 1: Identify the disease combination.
The patient has: \[ \text{HIV + multidrug-resistant tuberculosis} \]
Step 2: Recall MDR-TB regimen.
BPaLM includes: \[ \text{Bedaquiline + Pretomanid + Linezolid + Moxifloxacin} \] It is used for drug-resistant TB in suitable patients.
Step 3: Identify important monitoring.
In HIV-TB coinfection, immune recovery after ART may worsen inflammatory symptoms. This is called: \[ \text{Immune reconstitution inflammatory syndrome} \] Therefore, the correct answer is BPaLM; monitor for immune reconstitution syndrome.
Step 1: Identify the disease combination.
The patient has: \[ \text{HIV + multidrug-resistant tuberculosis} \]
Step 2: Recall MDR-TB regimen.
BPaLM includes: \[ \text{Bedaquiline + Pretomanid + Linezolid + Moxifloxacin} \] It is used for drug-resistant TB in suitable patients.
Step 3: Identify important monitoring.
In HIV-TB coinfection, immune recovery after ART may worsen inflammatory symptoms. This is called: \[ \text{Immune reconstitution inflammatory syndrome} \] Therefore, the correct answer is BPaLM; monitor for immune reconstitution syndrome.
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