New vaccines for the prevention of tuberculosis in human immunodeficiency virus infection [Perspectives]
Abstract:The prevention of human immunodeficiency virus (HIV) associated tuberculosis (TB) remains challenging. Several vaccines against TB have advanced to clinical trials in patients with HIV infection. The DarDar Trial, a large, randomized, placebo-controlled efficacy trial conducted in Tanzania, has demonstrated that a multiple dose series of an inactivated whole cell mycobacterial vaccine is safe in HIV and can prevent HIV-associated TB in patients with childhood bacille Calmette-Guérin vaccination and CD4 counts of ≥200 cells/mm3. These developments offer promise that in the not too distant future immunization with an effective vaccine against TB can be added to other strategies for the prevention of HIV-associated TB. This expanded approach is referred to as the Five ‘I's’: intensified case finding, infection control, isoniazid preventive therapy (IPT), initiation of antiretroviral therapy (ART), and immunization against TB. We encourage additional studies of new TB vaccines in HIV, and propose a strategy to reduce the risk of TB by integrating IPT, ART and immunization into routine HIV care. At the time of HIV diagnosis, patients with CD4 counts of ≥200 cells/mm3 could receive immunization, IPT and, as appropriate, ART. In patients presenting with lower CD4 counts or already on ART, immunization could be initiated at CD4 counts of ≥200 cells/mm3 to add to the protection afforded by IPT and ART.
Document Type: Research Article
Affiliations: 1: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA 2: Muhmibili University of Health and Allied Sciences, Dar es Salaam, Tanzania 3: Tufts University School of Medicine, Boston, Massachusetts, USA 4: National AIDS Control Programme, Dar es Salaam, Tanzania 5: National Programme on Tuberculosis and Leprosy, Dar es Salaam, Tanzania
Publication date: 2012-06-01
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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