Drug-resistant tuberculosis treatment

2.4 Subgroup considerations
Following the GDG’s assessment of the current evidence and judgements, the considerations were 
discussed for specific subgroups, as outlined in this
section.
People living with HIV. The data evaluated corresponded to a setting with a high prevalence of HIV 
(slightly above 70% in the dataset). More than 95% of PLHIV initiated on the all-oral bedaquiline-
containing regimen were on ART. In view of the treatment outcomes described in the analysis, there 
were no grounds to believe that the regimen would perform any differently in PLHIV. However, because 
the data evaluated did not include information on changes to the regimen as a result of management 
of adverse drug reactions, or complications from drug–drug interactions, the GDG reiterated that it 
is worth paying attention to any potential drug–drug interactions or overlapping drug toxicities that 
may not have been captured. For example, bedaquiline concentrations can be reduced by efavirenz 
(they should not be co-administered) or increased by boosted protease inhibitors (resulting in a need 
for greater vigilance in monitoring for drug-related QT effects) (53–55). Neuropathy, liver enzyme 
elevations and central nervous system (CNS) side-effects can be attributed to HIV or TB drugs or 
their interactions (56).
Children. Although the analysis attempted to provide further insights into the use of the all-oral 
bedaquiline-containing regimen in special populations, the limited sample of children aged under 
14 years in the database (n=6) meant that no direct outcome estimations could be drawn for this 

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WHO consolidated 
guidelines 
on
tuberculosis: 
drug-resistant tuberculosis treatment
17
population. However, because the components of the all-oral bedaquiline-containing regimen have 
been used in children, extrapolation was deemed reasonable, provided that considerations for 
the implementation of bedaquiline in children are followed (11). Earlier recommendations on the 
composition of longer regimens indicated that bedaquiline could also be included in such regimens 
for patients aged 6–17 years (11); hence, the all-oral bedaquiline-containing regimen may be used in 
eligible children aged 6 years
33
and above, taking into account considerations for specific medications.