{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:04:43Z","timestamp":1790370283585,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,6,20]],"date-time":"2014-06-20T00:00:00Z","timestamp":1403222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Buruli Ulcer (<jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content>)\u2013<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> co\u2010infection is an important emerging management challenge for <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> disease. Limited by paucity of scientific studies, guidance for management of this co\u2010infection has been lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Initiated by <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>, a panel of experts in <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> management developed guidance principles for the management of <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> co\u2010infection based on review of available scientific evidence, current treatment experience, and global recommendations established for management of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infection and tuberculosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The expert panel agreed that all <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> patients should be offered quality provider\u2010initiated <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing and counselling. In areas with high prevalence of malaria and\/or bacterial infections, all patients with <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> co\u2010infection should be started on cotrimoxazole preventative therapy. Combination antibiotic treatment for <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> should be commenced before starting antiretroviral therapy (ART) and provided for 8\u00a0weeks duration. The suggested combination is rifampicin (10\u00a0mg\/kg daily up to a maximum of 600\u00a0mg\/day) plus streptomycin (15\u00a0mg\/kg daily). An alternative regimen is rifampicin plus clarithromycin (7.5\u00a0mg\/kg twice daily up to a maximum of 1000\u00a0mg daily) although due to drug interactions with antiretroviral drugs this regimen should be used with caution. <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> should be initiated in all <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> co\u2010infected patients with symptomatic <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> disease (<jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> clinical stage 3 or 4) regardless of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 cell count and in asymptomatic individuals with <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count \u2264500 cells\/mm<jats:sup>3<\/jats:sup>. If <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count is not available, <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> co\u2010infected individuals with category 2 or 3 <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> disease should be offered <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>. For eligible individuals, <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> should be commenced as soon as possible within 8\u00a0weeks after commencing <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> treatment, and as a priority in those with advanced <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> disease (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4\u00a0\u2264\u00a0350 cells\/mm<jats:sup>3<\/jats:sup> or <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> stage 3 or 4 disease). All co\u2010infected patients should be actively screened for tuberculosis before commencing <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> treatment and before starting <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>. Programmes should implement a monitoring and reporting system to document the outcomes of <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Knowledge of the clinical and epidemiological interactions between <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> disease is limited. While awaiting more urgently needed evidence, current management practice of both diseases has been useful to build simple \u2018common sense\u2019 preliminary guidance on how to manage <jats:styled-content style=\"fixed-case\">BU<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> co\u2010infection.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12342","type":"journal-article","created":{"date-parts":[[2014,6,20]],"date-time":"2014-06-20T06:02:47Z","timestamp":1403244167000},"page":"1040-1047","source":"Crossref","is-referenced-by-count":13,"title":["Management of <scp>BU<\/scp>\u2013<scp>HIV<\/scp> co\u2010infection"],"prefix":"10.1111","volume":"19","author":[{"given":"D. P.","family":"O'Brien","sequence":"first","affiliation":[{"name":"Manson Unit M\u00e9decins Sans Fronti\u00e8res London UK"},{"name":"Department of Infectious Diseases Barwon Health Geelong Vic. 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