16.4 Latent tuberculosis infection in people with HIV infection

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    Treatment of LTBI reduces the risk of active TB by 33-64% [1] Citation 1. Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2010;1.
    https://doi.org/10.1002/14651858.CD000171.pub3         .

     

    For people not yet on antiretroviral treatment (ART), ART initiation should take priority over initiation of LTBI treatment.
    Among these persons, there is a high proportion of undiagnosed, asymptomatic TB cases and it is important to use all existing diagnostic means to rule out active TB.

     

    Note: a treatment programme for LTBI should be combined with a screening programme for active TB in people with HIV infection (Chapter 6).

    16.4.1 Children

    HIV-exposed  children a Citation a. HIV-exposed children are children born to HIV-infected women whose HIV status has not been established and/or are still at risk of infection (e.g. still breastfed).  and children with HIV infection and who do not have active TB (for evaluation, see Chapter 4) should receive LTBI treatment:

    • After contact with a TB case, including smear-positive, smear-negative and extrapulmonary TB (EPTB), regardless of their age;
    • In high TB transmission areas: if aged 12 months and over, regardless of their contact history.

     

    In addition, for children treated for active TB and living in high TB transmission areas, LTBI treatment may also be prescribed immediately after the successful completion of TB treatment to reduce the risk of reinfection.

    16.4.2 Adolescents and adults 

    Adolescents and adults who do not have active TB should receive LTBI treatment, regardless of contact history and TB prevalence in the area.
    In areas with high TB transmission, adolescents and adults with a LTBI test positive or unknown and who are unlikely to have active TB (no cough, no fever, no weight loss, no night sweats) should receive the treatment for at least 36 months (long-term regimen).
    This regimen is more effective in preventing TB in adults with a positive TST than in those with a negative TST [2] Citation 2. Den Boon S, Matteelli A, Ford N, Getahun H. Continuous isoniazid for the treatment of latent tuberculosis infection in people living with HIV: a systematic review and meta-analysis. 2016 Mar;30(5):797. 
    https://doi.org/10.1097/QAD.0000000000000985         .

     

    If TST is not feasible, or where the national guidelines do not recommend long-term isoniazid monotherapy, adolescents and adults without any TB symptoms should receive another LTBI treatment (6H or a rifapentine- or rifampicin-containing regimen).

     

    Table 16.2 – LTBI treatments for people with HIV infection [3] Citation 3. World Health Organization. WHO consolidated guidelines on tuberculosis: Module 1: prevention: tuberculosis preventive treatment. Geneva: World Health Organization. 2020.
    https://www.who.int/publications/i/item/who-consolidated-guidelines-on-tuberculosis-module-1-prevention-tuberculosis-preventive-treatment

     

    Age

    Recommended regimens

    Alternative regimens

    Child < 2 years

    6H or 3HR

    4R

    Child ≥ 2 years

    6H or 3HP or 3HR 

    4R

    Adolescent and adult

    6H or 3HP or 3HR or 36H 

    1HP (if ≥ 13 years) or 4R

     

    Footnotes
    • (a)HIV-exposed children are children born to HIV-infected women whose HIV status has not been established and/or are still at risk of infection (e.g. still breastfed). 
    References
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