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Free Content Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

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People living with the human immunodeficiency virus (HIV) (PLHIV) are at high risk for tuberculosis (TB), and TB is a major cause of death in PLHIV. Preventing TB in PLHIV is therefore a key priority. Early initiation of antiretroviral therapy (ART) in asymptomatic PLHIV has a potent TB preventive effect, with even more benefits in those with advanced immunodeficiency. Applying the most recent World Health Organization recommendations that all PLHIV initiate ART regardless of clinical stage or CD4 cell count could provide a considerable TB preventive benefit at the population level in high HIV prevalence settings. Preventive therapy can treat tuberculous infection and prevent new infections during the course of treatment. It is now established that isoniazid preventive therapy (IPT) combined with ART among PLHIV significantly reduces the risk of TB and mortality compared with ART alone, and therefore has huge potential benefits for millions of sufferers. However, despite the evidence, this intervention is not implemented in most low-income countries with high burdens of HIV-associated TB. HIV and TB programme commitment, integration of services, appropriate screening procedures for excluding active TB, reliable drug supplies, patient-centred support to ensure adherence and well-organised follow-up and monitoring that includes drug safety are needed for successful implementation of IPT, and these features would also be needed for future shorter preventive regimens. A holistic approach to TB prevention in PLHIV should also include other important preventive measures, such as the detection and treatment of active TB, particularly among contacts of PLHIV, and control measures for tuberculous infection in health facilities, the homes of index patients and congregate settings.
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Keywords: TB; antiretroviral therapy; human immunodeficiency virus/acquired immune-deficiency syndrome; infection control; isoniazid preventive treatment

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, London School of Hygiene & Tropical Medicine, London, UK 2: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France 3: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Myanmar Office, Mandalay, Myanmar 4: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, India 5: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 6: Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, Vital Strategies, New York, New York, USA 7: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Uganda Office, Kampala, Uganda 8: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, DRC Office, Kinshasa, Democratic Republic of Congo 9: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Mère et enfant face aux infections tropicales Institut de recherche pour le développement, Université Paris 5, Sorbonne Paris Cité, Paris, France 10: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, China Office, Beijing, China 11: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Zimbabwe Office, Harare, Zimbabwe 12: Vital Strategies, New York, New York, USA 13: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Damien Foundation, Brussels, Belgium 14: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Vital Strategies, New York, New York, USA 15: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, Peru Office, Lima, Peru 16: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, University of Bergen, Bergen, Norway 17: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Pneumology Department, Dr Negrin General Hospital of Gran Canaria, Las Palmas, Spain 18: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia

Publication date: February 1, 2019

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  • 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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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