Table 1.

Priority Research Areas for HIV Infection and Tuberculosis (TB)

Research area	Priorities
Diagnostics: TB case detection in HIV-infected persons	Development of an accurate, rapid, point-of-care test accessible to remote clinics; development of sputum NAAT with improved sensitivity to diagnose AFB smear–negative TB; advancement of serum- and urine-based testing with efficacy for smear-negative and extrapulmonary TB; strategies to reduce the cost, complexity, and processing requirements of mycobacterial liquid culture
Treatment for TB and HIV infection
Treatment for HIV infection	Defining the optimal timing of ART during coinfection; comparative efficacy studies of first-line ART regimens using optimal ART dosages during TB therapy; determination of the safety and efficacy of dose-adjusted HIV protease inhibitors coadministered with rifampin
Treatment for TB	Comparative studies of rifabutin- and rifampin-based regimens; development of TB treatment–shortening strategies for HIV-infected patients; early identification of appropriate dosages and drug interactions between new TB drugs and ART; development of surrogate markers for TB treatment failure; determination of the optimal duration of corticosteroids for IRIS and development of novel methods to prevent IRIS
Drug-Resistant TB	Role of new TB agents in HIV-infected patients with MDR- or XDR-TB; determination of the efficacy of new TB agents to prevent disease in contacts of persons with MDR- or XDR-TB; impact of ART use, level of HIV immunosuppression, and choice of TB treatment regimens on the acquisition and transmission of MDR- and XDR-TB; determination of the performance of existing drug-susceptibility testing with second-line agents
TB prevention
Infection control	Development of novel, low-cost, and culturally acceptable TB infection-control strategies; epidemiologic studies clarifying where, when, and how often community TB transmission is occurring in areas with a high burden of TB and HIV infection
IPT	Determination of the best choice of drugs for TB prevention to achieve prolonged efficacy with minimal adverse effects in HIV-infected persons; improvement in strategies for ruling out active TB before IPT
Vaccines	TB vaccine development in HIV-infected adults and children
Pediatric TB and HIV infection	Development and validation of non–sputum-based TB testing in young children; optimal use of interferon-g release assays in children; optimal duration and development of guidelines for IPT use in HIV-infected children; improvement in pediatric clinical trials infrastructure to address the optimal treatment duration, dosages, and pharmacokinetics of ART and anti-TB therapy; TB prevention strategies in HIV-infected children that incorporate household-level infection control and vaccine development

NOTE. AFB, acid-fast bacilli; ART, antiretroviral therapy; IPT, isoniazid preventive therapy; IRIS, immune reconstitution inflammatory syndrome; MDR, multidrug resistant; NAAT, nucleic acid amplification testing; XDR, extensively drug resistant.