WHO issues guidelines on TB prevention in people with HIV in resource-constrained settings

The World Health Organization issued new guidelines last week on preventing tuberculosis (TB) in people with HIV infection in resource-constrained settings.

Although HIV-infected people are more likely to develop active TB, isoniazid preventive therapy (IPT), a cost-effective way to protect against TB, is often underused in this population, the WHO said in a press release.

The guidelines' key recommendations, which update the WHO's 1998 policy on this topic, are as follows:

• All HIV-infected children and adults, including pregnant women and those on antiretroviral treatment, should receive IPT.
• IPT should be taken for six to 36 months, or for life in settings where HIV and TB are highly prevalent.
• HIV-infected people with TB symptoms, such as cough, fever, weight loss or night sweats, should be further screened for active TB or other conditions so they can be treated appropriately.

Chest radiography is no longer required before starting IPT in HIV-infected patients, nor is a positive tuberculin skin test needed, although the latter "may be done as a part of eligibility screening in some settings," according to the guidelines. "The provision of IPT should not be viewed as an isolated intervention for people living with HIV. Rather, it should be part of a TB prevention package along with infection control for TB, [intensified case-finding] and provision of [antiretroviral therapy]," the guidelines stated.