HIV/AIDS

Preventive therapy and intensified case finding for TB in people living with HIV

Guidelines meeting

25-27 January 2010

The WHO HIV/AIDS and Stop TB Departments hosted a joint meeting with key experts, 25-27 January 2010 to prepare guidelines on preventive therapy and intensified case finding for TB in people living with HIV. The WHO/UNAIDS 1998 Policy statement on preventive therapy against TB in people living with HIVwill be updated to produce new WHO guidelines, reconceptualising TB preventive therapy and intensified TB case finding, as integral parts of HIV treatment, care and support services.

Tuberculosis (TB) is the most frequent life threatening opportunistic disease among people living with HIV (PLHIV) and is the leading cause of death and yet TB is preventable and curable.

At the end of 2007, approximately 33.2 million people were living with HIV and approximately 2 billion people (one third of the world’s population) were infected with Mycobacterium tuberculosis. In the same year there were 1.37 million new TB cases among PLHIV and 456 000 TB related deaths. The Global TB control report 2009 states that that one in four TB deaths is HIV related. These facts point to an urgent need to find prevent and treat TB in people living with HIV.

The Three I’s, Isoniazid preventive treatment (IPT), infection control (IC) and intensified case finding (ICF) are three priority public health actions to prevent and treat TB in people living with HIV, other vulnerable patients and the community. Despite the considerable benefits of the Three I’s, many countries have been slow to implement these TB-reducing services.

In 2008, for example, of the estimated 33.4 million PLHIV, only 50 000 were offered IPT, which has resulted in missed opportunities to prevent many unnecessary cases of TB and related deaths. To address the significant gap in progress in scaling up the Three I’s, WHO convened a meeting with other key partners in April 2008, which called for an update of the WHO/UNAIDS policy on preventive therapy against tuberculosis in people living with HIV.

In response to the Three I’s meeting, WHO HIV/AIDS and TB Departments will host a joint meeting with key experts 25-27 January, to reconceptualise IPT and ICF as integral parts of HIV treatment, care and support services. The overall objective of the meeting is to update the WHO/UNAIDS 1998 Policy statement on preventive therapy against TB in people living with HIV [pdf 507kb] to prepare new WHO guidelines on preventive therapy and case finding of TB in people living with HIV.

The specific objectives of the meeting are to:

    • determine the best combination of signs, symptoms and diagnostic procedures (e.g., smear microscopy, radiography, serum-based tests such as IGRA, etc.) as screening tools to determine eligibility for latent TB infection (LTBI) treatment and to diagnose TB among PLHIV;
    • determine whether treatment for LTBI among PLHIV leads to significant developments of mono-resistance against the drugs used for LTBI treatment;
    • define the optimal duration and drug regimen (e.g., INH, RIF, etc.) for treatment of LTBI to reduce the risk of developing Tuberculosis among PLHIV;
    • define the optimal time to start considering IPT (i.e., should immune status be considered and should IPT be started with ART);
    • determine whether low adherence rates to LTBI treatment are a barrier to the implementation of LTBI treatment among PLHIV;
    • determine whether the provision of treatment for LTBI is cost-effective;
    • discuss purified protein derivative (PPD) in resource-limited settings;
    • determine whether PLHIV who had received TB treatment in the past are provided secondary treatment of LTBI to prevent re-infection or recurrence of Tuberculosis.

Approximately 69 people representing 5 regions and 25 different countries will take part in the meeting. The meeting will bring together a broad range of stakeholders: researchers, programme implementers, representatives of Ministries of Health, policy makers, civil society representatives, people living with HIV, gender advocates, UN agencies and donor agencies.

WHO will circulate a report after the consultation, with an overview of key recommendations and next steps.


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