Adults and adolescents living with HIV

Adults and adolescents living with HIV who have an unknown or positive
TST status and who are unlikely to have active TB should receive at
least six months of IPT as part of a comprehensive package of HIV
care. IPT should be given to such individuals irrespective of the degree
of immunosuppression, and also to those on ART, those who have
previously been treated for TB and pregnant women.
Adults and adolescents living with HIV who have an unknown or positive
TST status and are unlikely to have active TB should receive at least 36
months of IPT. IPT should be given to such individuals irrespective of the
degree of immunosuppression, and also to those on ART, those who have
previously been treated for TB and pregnant women.
The Guidelines Group reviewed the available
evidence regarding the benefit of chemotherapy
to prevent TB disease (latent disease,
reactivation or reinfection) in adults living with HIV
(Annex 6). A GRADE assessment was used to
examine the existing evidence on drug regimens
including the 12 randomized controlled trials used in
the Cochrane review of preventive therapy.[16] For
those with confirmed, probable or possible TB disease,
preventive chemotherapy reduces the overall risk of
developing TB by 33% (relative effect 0.67; CI 0.51–
0.87). For those who were TST positive, the reduction
in confirmed, probable or possible TB increased to
64% (RR [95% CI] 0.36 [0.22–0.61]). Although not
statistically significant, the reduction among TSTnegative
persons was 14% (RR [95% CI] 0.86 [0.59,
1.26]) and in those with unknown TST status it fell by
14% (RR [95% CI] 0.86 [0.48, 1.52]).[16] The Guidelines
Group concluded that there is benefit in providing TB
preventive therapy to people living with HIV regardless
of the TST status, with greater protective benefit seen
in those with a positive TST.