HIV is the strongest risk factor for developing

HIV is the strongest risk factor for developing
tuberculosis (TB) disease in those with latent
or new Mycobacterium tuberculosis infection.
The risk of developing TB is between 20 and 37 times
greater in people living with HIV than among those
who do not have HIV infection.[1] TB is responsible
for more than a quarter of deaths among people living
with HIV.[2] Relatively more women than men were
detected to have TB in countries with a prevalence
of HIV infection of more than 1% [1]. In response
to the dual epidemics of HIV and TB, the World
Health Organization (WHO) has recommended 12
collaborative TB/HIV activities as part of core HIV
and TB prevention, care and treatment services.[3]
These include interventions that reduce the morbidity
and mortality from TB in people living with HIV, such
as the provision of antiretroviral therapy (ART) and
the Three I’s for HIV/TB: intensified case-finding of
TB (ICF), isoniazid preventive therapy (IPT) and
infection control for TB.[4]
A high rate of previously undiagnosed TB is common
among people living with HIV.[5,6] ICF and treatment
of TB among people living with HIV interrupts disease
transmission by infectious cases,[7,8] reduces
morbidity and delays mortality.[9] Most importantly,
active screening for TB offers the opportunity to
provide preventive therapy for those who do not have
symptoms and signs of TB.[10]
IPT is a key public health intervention for the
prevention of TB among people living with HIV and
has been recommended since 1998 by WHO and
the Joint United Nations Programme on HIV/AIDS
(UNAIDS) as part of a comprehensive HIV and AIDS
care strategy.[11] It has subsequently been included in
a number of WHO guidelines and recommendations.
[3,12] However, its implementation has been very
slow and has been impeded by several barriers
including lack of an accepted approach to exclude
active TB disease and restricted access to isoniazid
for fear of developing drug resistance. By the end
of 2009, globally only 85 000 people living with HIV
received IPT.[1] It is not known what proportion of
these were children.
In April 2008, WHO convened the Three I’s for HIV/
TB Meeting, which called for a re-conceptualization
of the existing WHO/UNAIDS Policy on IPT to reflect
new scientific evidence and thinking about HIV and
TB prevention, care and treatment, and expedite
the implementation of this important intervention in
tandem with ICF.[4] Therefore, the objective of these
guidelines is to provide guidance for national TB
and AIDS programmes by updating existing WHO
recommendations with new evidence, taking into
consideration the changing context of HIV and TB
prevention, treatment and care. The new guidelines
focus on facilitating the implementation of IPT and
ICF. The guidelines are also intended to highlight
and strengthen the leadership role of national AIDS
programmes and HIV stakeholders to scale up the
implementation of TB screening and provision of IPT
among people living with HIV.