Tuberculose en HIV

Initiatief: CPT Aantal modules: 30

Behandeling van gecombineerd tuberculose en HIV

Deze module is onderverdeeld in de volgende submodules:

  • Behandeling tuberculose
    • Keuze tbc-geneesmiddelen
    • Duur van de tbc-behandeling
    • Dosisaanpassingen en bloedspiegels
  • Behandeling HIV: antiretrovirale therapie (ART)
    • Tijd van starten van ART
    • Keuze van ART tijdens de tbc-behandeling
    • Monitoring van hiv-behandeling tijdens de tbc-behandeling
    • Geneesmiddeleninteracties
  • Immuun reconstitutie inflammatoir syndroom (IRIS)
    • Wat is IRIS?
    • Behandeling en preventie van IRIS


  1. 1 - British HIV Association guidelines for the management of tuberculosis in adults living with HIV 2018 (2019 interim update).
  2. 2 - Ellis PK, Martin WJ, Dodd PJ. CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis. PeerJ [Internet]. 2017 Dec 14 [cited 2019 Aug 11];5. Available from:
  3. 3 - Lodi S, del Amo J, d’Arminio Monforte A, Abgrall S, Sabin C, Morrison C, et al. Risk of tuberculosis following HIV seroconversion in high-income countries. Thorax. 2013 Mar;68(3):207–13.
  4. 4 - Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2010;(1):CD000171.
  5. 5 - Norrby M, Wannheden C, Ekström AM, Berggren I, Lindquist L. Incidence of tuberculosis and the need of prophylactic treatment in persons living with HIV in Stockholm during the era of anti-retroviral therapy 1996-2013. Infect Dis (Lond). 2018 Dec;50(11–12):807–16.
  6. 6 - Elzi L, Schlegel M, Weber R, Hirschel B, Cavassini M, Schmid P, et al. Reducing tuberculosis incidence by tuberculin skin testing, preventive treatment, and antiretroviral therapy in an area of low tuberculosis transmission. Clin Infect Dis. 2007 Jan 1;44(1):94–102.
  7. 7 - Martínez-Pino I, Sambeat MA, Lacalle-Remigio JR, Domingo P, VACH Cohort Study Group. Incidence of tuberculosis in HIV-infected patients in Spain: the impact of treatment for LTBI. Int J Tuberc Lung Dis. 2013 Dec;17(12):1545–51.
  8. 8 - Group TTA 12136 S. A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa [Internet]. 2015 [cited 2019 Aug 11]. Available from:
  9. 9 - Cattamanchi A, Smith R, Steingart KR, Metcalfe JZ, Date A, Coleman C, Marston BJ, Huang L, Hopewell PC, Pai M. Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2011 Mar 1;56(3):230-8. doi: 10.1097/QAI.0b013e31820b07ab. Review. PubMed PMID: 21239993; PubMed Central PMCID: PMC3383328.
  10. 10 - Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at
  11. 11 - Kerkhoff AD, Gupta A, Samandari T, Lawn SD. The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5 mm or a 10 mm cut-off: a systematic review. BMC Infect Dis. 2013 Dec;13(1):307.
  12. 12 - Martinson NA, Barnes GL, Moulton LH, Msandiwa R, Hausler H, Ram M, et al. New regimens to prevent tuberculosis in adults with HIV infection. N Engl J Med. 2011;365:11–20.
  13. 13 - Latent tuberculosis infection. Updated and consolidated guidelines for programmatic management. Geneva: World Health Organization; 2018. Report No.: WHO/CDS/TB/2018.4.
  14. 14 - Stagg HR, Zenner D, Harris RJ, Muñoz L, Lipman MC, Abubakar I. Treatment of Latent Tuberculosis Infection: A Network Meta-analysis. Ann Intern Med. 2014 Aug 12;
  15. 15 - CPT-richtlijn Behandeling latente tuberculose-infectie. Den Haag: KNCV Tuberculosefonds; 2015.
  16. 16 - CPT-richtlijn Tuberculose-HIV [Internet]. Den Haag: KNCV Tuberculosefonds; 2016. Available from:
  17. 17 - NVMM-richtlijn Mycobacteriële laboratoriumdiagnostiek. Nederlandse Vereniging voor Medische Microbiologie; 2015.
  18. 18 - Bahr NC, Nuwagira E, Evans EE, Cresswell FV, Bystrom PV, Byamukama A, et al. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study. The Lancet Infectious Diseases. 2018 Jan;18(1):68–75.
  19. 19 - Compendium of WHO guidelines and associated standards: ensuring optimum delivery of the cascade of care for patients with tuberculosis. Geneva: World Health Organization; 2017. Report No.: WHO/HTM/TB/2017.13.
  20. 20 - Drain PK, Heichman KA, Wilson D. A new point-of-care test to diagnose tuberculosis. Lancet Infect Dis. 2019 May 30;
  21. 21 - Broger T, Sossen B, du Toit E, Kerkhoff AD, Schutz C, Ivanova Reipold E, et al. Novel lipoarabinomannan point-of-care tuberculosis test for people with HIV: a diagnostic accuracy study. Lancet Infect Dis. 2019 May 30;
  22. 22 - WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders. Geneva: World Health Organization; 2012. Report No.: WHO/HTM/TB/2012.1.
  23. 23 - NVALT-richtlijn Medicamenteuze behandeling van tuberculose. Nederlandse Vereniging van Artsen voor Longziekten en Tuberculose; 2014.
  24. 24 - CPT-richtlijn Tuberculose-HIV. Commissie voor Praktische Tuberculosebestrijding, KNCV Tuberculosefonds; 2008.
  25. 25 - Tuberculose Kerncijfers Nederland 2018. Bilthoven: RIVM; 2019.
  26. 26 - Arnoldussen M, Schimmel H, Op de Coul E, van den Hof S, de Vries G. Tuberculosis patients with unknown HIV status in the Netherlands: analysing underreporting and lack of testing. Eur Respir J. 2017 Nov;50(5).
  27. 27 - Op de Coul EL, Hahné S, van Weert YW, Oomen P, Smit C, van der Ploeg KP, et al. Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective. BMC Infectious Diseases. 2011;11:185.
  28. 28 - van Sighem AI, Boender TS, Wit FHNM, Smit C, Matser A, Reiss P. Monitoring Report 2018. Human Immunodeficiency Virus (HIV) Infection in the Netherlands [Internet]. Amsterdam: Stichting HIV Monitoring; 2018. Available from:
  29. 29 - Guidelines for the treatment of drug-susceptible tuberculosis and patient care: 2017 update. Geneve: World Health Organization; 2017. Report No.: WHO/HTM/TB/2017.05.
  30. 30 - WHO treatment guidelines for isoniazid-resistant tuberculosis: Supplement to the WHO treatment guidelines for drug-resistant tuberculosis. Geneva: World Health Organization; 2018. Report No.: WHO/CDS/TB/2018.7.
  31. 31 - WHO consolidated guidelines on drug-resistant tuberculosis treatment. World Health Organization; 2019.
  32. 32 - De Boer A, de Vries G. Nationaal Plan Tuberculosebestrijding 2011-2015. Inhoudelijke kaders. Bilthoven: RIVM; 2010.
  33. 33 - CPT-leidraad Preventie, diagnositek, behandeling en zorg rifampicine-resistente en multiresistente tuberculose: 2017 update. Den Haag: Commissie voor Praktische Tuberculosebestrijding, KNCV Tuberculosefonds; 2017.
  34. 34 - Meintjes G, Brust JCM, Nuttall J, Maartens G. Management of active tuberculosis in adults with HIV. The Lancet HIV. 2019 Jul;6(7):e463–74.
  35. 35 - Fiona V. Cresswell, Lindsey Te Brake, Rachel Atherton, Rovina Ruslami, Kelly E. Dooley, Rob Aarnoutse & Reinout Van Crevel (2019) Intensified antibiotic treatment of tuberculosis meningitis, Expert Review of Clinical Pharmacology, 12:3, 267-288, DOI: 10.1080/17512433.2019.1552831.
  36. 36 - Khan FA, Minion J, Pai M, Royce S, Burman W, Harries AD, et al. Treatment of active tuberculosis in HIV-coinfected patients: a systematic review and meta-analysis. Clin Infect Dis. 2010 May 1;50(9):1288–99.
  37. 37 - Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis. 2016 Aug 10;
  38. 38 - Sotgiu G, Nahid P, Loddenkemper R, Abubakar I, Miravitlles M, Migliori GB. The ERS-endorsed official ATS/CDC/IDSA clinical practice guidelines on treatment of drug-susceptible tuberculosis. European Respiratory Journal. 2016 Sep 1;ERJ-01356-2016.
  39. 39 - National Tuberculosis Control Plan 2016-2020. Towards elimination [Internet]. Bilthoven: RIVM; 2016. Available from:
  40. 40 - Sekaggya-Wiltshire C, von Braun A, Lamorde M, Ledergerber B, Buzibye A, Henning L, Musaazi J, Gutteck U, Denti P, de Kock M, Jetter A, Byakika-Kibwika P, Eberhard N, Matovu J, Joloba M, Muller D, Manabe YC, Kamya MR, Corti N, Kambugu A, Castelnuovo B, Fehr JS. Delayed Sputum Culture Conversion in Tuberculosis-Human Immunodeficiency Virus-Coinfected Patients With Low Isoniazid and Rifampicin Concentrations. Clin Infect Dis. 2018 Aug 16;67(5):708-716. doi: 10.1093/cid/ciy179. PubMed PMID: 29514175; PubMed Central PMCID: PMC6094003.
  41. 41 - Alkabab Y, Keller S, Dodge D, Houpt E, Staley D, Heysell S. Early interventions for diabetes related tuberculosis associate with hastened sputum microbiological clearance in Virginia, USA. BMC Infect Dis. 2017 Feb 6;17(1):125. doi: 10.1186/s12879-017-2226-y. PubMed PMID: 28166721.
  42. 42 - Alsultan A, Peloquin CA. Therapeutic drug monitoring in the treatment of tuberculosis: an update. Drugs. 2014 Jun;74(8):839-54.
  43. 43 - Magis-Escurra C, Later-Nijland HM, Alffenaar JW, Broeders J, Burger DM, van Crevel R, Boeree MJ, Donders AR, van Altena R, van der Werf TS, Aarnoutse RE. Population pharmacokinetics and limited sampling strategy for first-line tuberculosis drugs and moxifloxacin. Int J Antimicrob Agents. 2014 Sep;44(3):229-34.
  44. 44 - van Beek SW, Ter Heine R, Keizer RJ, Magis-Escurra C, Aarnoutse RE, Svensson EM. Personalized Tuberculosis Treatment Through Model-Informed Dosing of Rifampicin. Clin Pharmacokinet. 2019 Jun;58(6):815-826.
  45. 45 - Uthman OA, Okwundu C, Gbenga K, Volmink J, Dowdy D, Zumla A, Nachega JB. Optimal Timing of Antiretroviral Therapy Initiation for HIV-Infected Adults With Newly Diagnosed Pulmonary Tuberculosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Jul 7;163(1):32-9. doi: 10.7326/M14-2979. Review. PubMed PMID: 26148280.
  46. 46 - Török ME, Yen NT, Chau TT, Mai NT, Phu NH, Mai PP, Dung NT, Chau NV, Bang ND, Tien NA, Minh NH, Hien NQ, Thai PV, Dong DT, Anh DT, Thoa NT, Hai NN, Lan NN, Lan NT, Quy HT, Dung NH, Hien TT, Chinh NT, Simmons CP, de Jong M, Wolbers M, Farrar JJ. Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)--associated tuberculous meningitis. Clin Infect Dis. 2011 Jun;52(11):1374-83. doi: 10.1093/cid/cir230. PubMed PMID: 21596680; PubMed Central PMCID: PMC4340579.
  47. 47 - Meintjes G, Wilkinson RJ, Morroni C, Pepper DJ, Rebe K, Rangaka MX, et al. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2010 Sep 24;24(15):2381–90.
  48. 48 - Meintjes G, Stek C, Blumenthal L, Thienemann F, Schutz C, Buyze J, et al. Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS. New England Journal of Medicine. 2018 Nov 15;379(20):1915–25.
  49. 49 - WIP-richtlijn Ziekenhuizen. Tuberculose: preventie van aerogene besmetting. Werkgroep Infectie Preventie; 2016.
  50. 50 - CPT-richtlijn Tuberculose bron- en contactonderzoek. Den Haag: KNCV Tuberculosefonds; conceptversie augustus 2019.
  51. 51 - Jansen-Aaldring N, van de Berg S, van de Hof S. Patient support during treatment for active tuberculosis and for latent tuberculosis infection: Policies and practices in European low-incidence countries. Journal of Advanced Nursing.2018 Dec;74 (12): 2755-2765.
  52. 52 - National Institute for Health and Care Excellence NICE {NG33} Published date: January 2016 updated: September 2019.
  53. 53 - Wang Y, Collins C, Vergis M, Gerein N, Macq J. HIV/AIDS and TB: contextual issues and policy choice in programme relationships. Trop Med Int Health. 2007 Feb;12(2):183-94.
  54. 54 - Revised BCG vaccination guidelines for infants at risk for HIV infection. Wkly Epidemiol Rec. 2007 May 25;82(21):193–6.
  55. 55 - CPT-richtlijn Vaccinatie met bacillus Calmette-Guérin (BCG) tegen tuberculose. Den Haag: Commissie voor Praktische Tuberculosebestrijding, KNCV Tuberculosefonds; 2017.
  56. 56 - Hesseling AC, Rabie H, Marais BJ, Manders M, Lips M, Schaaf HS, et al. Bacille Calmette-Guerin vaccine-induced disease in HIV-infected and HIV-uninfected children. Clin Infect Dis. 2006;42:548–58.
  57. 57 - Hesseling AC, Marais BJ, Gie RP, Schaaf HS, Fine PEM, Godfrey-Faussett P, et al. The risk of disseminated Bacille Calmette-Guerin (BCG) disease in HIV-infected children. Vaccine. 2007 Jan 2;25(1):14–8.

Autorisatiedatum en geldigheid

Laatst beoordeeld  : 13-03-2020

Laatst geautoriseerd  : 13-03-2020

Geplande herbeoordeling  : 01-01-2027

Initiatief en autorisatie

  • Commissie voor Praktische Tuberculosebestrijding
Geautoriseerd door:
  • Nederlandse Internisten Vereniging
  • Nederlandse Vereniging van Artsen voor Longziekten en Tuberculose
  • Nederlandse Vereniging voor Kindergeneeskunde
  • Nederlandse Vereniging voor Medische Microbiologie

Samenstelling werkgroep

Leden van de werkgroep (in alfabetische volgorde):

  • Dr. M.J. (Martin) Boeree, longarts Tuberculosecentrum Dekkerswald, Universitair Centrum voor Chronische Longziekten, Radboud Universitair Medisch Centrum, Nijmegen
  • Prof. dr. R. (Reinout) van Crevel, internist-infectioloog, Radboudumc Nijmegen, voorzitter (namens de NVHB)
  • Drs. A.C. (Agnes) Gebhard, arts maatschappij en gezondheid, technisch directeur, KNCV Tuberculosefonds Den Haag
  • Dr. J. (Johanneke) Kleinnijenhuis, internist-infectioloog, UMC Groningen
  • Drs. D. (Inge) Koppelaar, arts maatschappij en gezondheid, senior consulent, KNCV Tuberculosefonds Den Haag, secretaris (vanaf 1-6-2019)
  • Dr. P. (Peter) Kouw, arts tuberculosebestrijding, GGD Amsterdam (namens de CPT)
  • Drs. N. (Nienke) Langebeek, Nurse Practitioner HIV, Ziekenhuis Rijnstate, Arnhem (namens V&VN, sectie VCH)
  • Drs. E.M.S. (Eliane) Leyten, internist-infectioloog, Stichting Medisch Centrum Haaglanden
  • Drs. A.M. (Annet) Reusken, sociaal verpleegkundige, GGD Amsterdam (namens V&VN, sectie VOGZ, commissie Tuberculose)
  • Dr. E.H. (Liesbeth) Schölvinck, kinderarts-infectioloog /immunoloog, UMC Groningen (namens de NVK)
  • Drs. R.P. (Reindert) van Steenwijk, longarts, AMC Amsterdam (namens de NVALT)
  • Dr. J.E.M. (Jurriaan) de Steenwinkel, arts-microbioloog, Erasmus MC Rotterdam, namens de NVMM
  • Prof. dr. A. (Annelies) Verbon, internist-infectioloog, Erasmus MC Rotterdam
  • Dr. G. (Gerard) de Vries, arts maatschappij en gezondheid/epidemioloog, KNCV Tuberculosefonds, Den Haag en landelijke coördinator tuberculosebestrijding bij het Centrum voor Infectieziektebestrijding, RIVM, Bilthoven (secretaris tot 1-6-2019)
  • Dr. F.W. Wit (Ferdinand), senior onderzoeker, AMC Amsterdam (namens Stichting HIV Monitoring)

De eerste druk van deze richtlijn werd in 2013 opgesteld in samenwerking met: - Nederlandse Vereniging van HIV Behandelaren (NVHB) - Nederlandse Vereniging van Artsen voor Longziekten en Tuberculose (NVALT) - Nederlandse Vereniging voor Kindergeneeskunde (NVK) Nederlandse Vereniging voor Medische Microbiologie (NVMM) - Vereniging voor Infectieziekten (VIZ) Verpleegkundigen en Verzorgenden Nederland, sectie VOGZ, commissie Tuberculose (V&VN commissie TBC) - Verpleegkundigen en Verzorgenden Nederland - Verpleegkundig Consulenten Hiv/Aids (VCHA).

De eerste druk van deze richtlijn op 28 juni 2013 door de Commissie voor Praktische Tuberculosebestrijding vastgesteld. Hoofdstukken 2 en 3 zijn in 2015 gereviseerd en op 25 september 2015 door de Commissie voor Praktische Tuberculosebestrijding vastgesteld.

Deze herziene uitgave is 13 maart 2020 door de Commissie voor Praktische Tuberculosebestrijding vastgesteld. Revisie 2025

Methode ontwikkeling

Evidence based