Tuberculosis prevention for people with HIV

Children and adults living with HIV can be protected from one of their deadliest threats – tuberculosis (TB) – with a regular, low-cost preventive medication according to new guidelines launched today by the WHO. Of the nearly two million AIDS-related deaths each year, a quarter of them are associated with TB.

Because of their weakened immune system, people living with HIV are less able to fight TB infection and are more likely to develop active TB which can be deadly and can spread to others. In some communities, up to 80% of people with TB test positive for HIV. Taking medicine containing the anti-TB drug isoniazid is a simple and cost-effective measure that prevents the TB bacteria from becoming active if it is present. Known as Isoniazid Preventive Therapy (IPT), the treatment approach is not new, but for a variety of reasons it is underused. Only 85 000 (or 0.2%) of all people living with HIV received isoniazid for TB prevention in 2009.

“As we commemorate World AIDS Day, it is clear that managing HIV must include addressing TB,” said Dr Gottfried Hirnschall, Director of WHO’s HIV/AIDS Department. “We need to fully implement the WHO Three I’s for HIV/TB strategy in collaboration with all partners. The Three I’s are Isoniazid Preventive Therapy, Intensified TB screening and Infection control for TB. These measures should be delivered as part of comprehensive HIV services.”

Key recommendations

The guidelines are based on new scientific evidence that updates the previous 1998 policy. The key recommendations are:

  • All children and adults living with HIV, including pregnant women and those receiving antiretroviral treatment, should receive isoniazid prevention therapy.
  • Isoniazid should be provided for six to 36 months, or as a life-long treatment in settings with high HIV and TB prevalence.
  • People living with HIV who may have TB symptoms should be further screened for active TB or other conditions so that they are able to access the appropriate treatments.

“In many countries HIV is a major driver of the TB epidemic. TB is preventable and curable and the new guidelines show how to break the chain that links TB and HIV leading to death,” said Dr Mario Raviglione, Director of WHO’s Stop TB Department. “All countries and communities need to implement the new guidelines and WHO can provide the necessary support to ensure that this can happen.”

Misconceptions that may contribute to the low uptake of isoniazid therapy are also addressed in the new guidelines. For example, concern that using isoniazid without other TB medications causes resistance to the medicine was not found to be supported by any scientific evidence. These and other clarifications featured in the guidelines should clear the way for greater access to the preventive therapy for millions of people living with HIV.

report from WHO

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