Correct!
5. Rifampin, pryizinamide, ethambutol, levofloxacin, hold Biktarvy for four weeks.

The patient has been on Isoniazid for treatment of latent TB. Due to active symptoms and paratracheal lymphadenopathy, there would be a high suspicion for isoniazid resistance. When there is clinical suspicion for isoniazid resistance, isoniazid should be held and a fluoroquinolone should be started (6). The most common mechanism of resistance to isoniazid is inhA and katG. Biktarvy should be held up to four weeks while initiating TB therapy to decrease the risk of immune reconstitution inflammatory syndrome (IRIS). IRIS is paradoxical worsening of preexisting infectious processes such as TB. In a secondary analysis of the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) trial, restarting anti-retroviral therapy (ART) in the first four weeks of tuberculosis treatment was associated with a two-fold higher incidence of IRIS (7).

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References

  1. Fishman J and Sagar M. Spectrum Diagnosis. AIDS Patient Care STDS. 1999;13(11):645-9. [CrossRef] [PubMed]
  2. Jasmer RM, Gotway MB, Creasman JM, Webb WR, Edinburgh KJ, Huang L. Clinical and radiographic predictors of the etiology of computed tomography-diagnosed intrathoracic lymphadenopathy in HIV-infected patients. J Acquir Immune Defic Syndr. 2002;31(3):291-8. [CrossRef] [PubMed]
  3. Prasad KT, Muthu V, Sehgal IS, et al. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in HIV-infected patients with undiagnosed intrathoracic lymphadenopathy. Lung India. 2018;35(5):173-5. [CrossRef] [PubMed]
  4. Navani N, Molyneaux PL, Breen RA, et al. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study. Thorax. 2011;66(10):889-93. [CrossRef] [PubMed]
  5. Aaron L, Saadoun D, Calatroni I, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004;10(5):388-98. [CrossRef] [PubMed]
  6. WHO. WHO treatment guidelines for drug-resistant tuberculosis. World Heal Organization. 2016:1-30. [CrossRef] [PubMed]
  7. Naidoo K, Yende-Zuma N, Padayatchi N, et al. Immune reconstitution inflammatory syndrome following antiretroviral therapy initiation in tuberculosis patients: findings from the SAPiT trial. NIH Public Access. 2013;18(5):1199-1216. [CrossRef] [PubMed]

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