The World Health Organization (WHO) has released updated guidelines for preventing TB among persons living with HIV in resource-limited countries, including the recommendation that those presenting without active TB receive at least six months of isoniazid prophylaxis treatment (IPT).
TB is the most common killer of HIV positive people, and approximately 380,000 people living with HIV die from TB every year.
In order to adequately identify candidates for the isoniazid therapy, a simple, standardized TB screening rule for people living with HIV in resource-constrained settings is included in the guidelines. A new study presented in PloS Medicine this week by lead author Haileyesus Getahun, MD, PhD, MPH, worked to identify four symptoms among HIV positive people – current cough, fever, night sweats and weight loss – that were likely to pinpoint those in need of further diagnostic assessment for TB. Those without any of these symptoms had a low probability of having TB.
“Use of this algorithm should result in earlier TB diagnosis and treatment, and should allow for substantial scale-up of IPT,” according to the study abstract.
In a public comment responding to the guidelines, Humphrey Fellow in the Hubert Department of Global Health at Emory University Ashraf Mohammed, PhD, and Center for Global Health Policy Scientific Advisory Board Member Carlos del Rio, MD, said “…Most countries with raging HIV/TB epidemics have not implemented TB screening, and rates of IPT use are abysmal,” while lauding the guidelines. “Having a simple algorithm for identifying patients with possible TB disease — and removing the need for [a tuberculin skin test] or a chest x-ray before starting IPT — is a giant step forward that may help reduce the burden of TB disease among HIV-infected people.”
This is the first update to the guidelines in more than a decade. “Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings,” are available on the WHO website.
Development of a Standardized Screening Rule for Tuberculosis in People Living with HIV in Resource-Constrained Settings: Individual Participant Data Meta-analysis of Observational Studies - Link
Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource constrained settings - Link