Feature Story

Tuberculosis (TB) is a leading cause of death among people with HIV and, in order to mitigate this threat, low-cost preventive therapy is essential. In new guidelines released today, the World Health Organization (WHO) sets out how such therapy can be accessed safely and effectively.

According to WHO, the anti-TB drug isoniazid has a dramatic positive impact and the guidelines, aimed at resource-constrained settings, promote the use of Isoniazid Preventive Therapy (IPT) as a simple and cost-effective method that stops TB bacteria becoming active. A quarter of the nearly two million AIDS-related deaths each year is associated with TB and in some communities up to 80% of people who test positive for tuberculosis are also living with HIV.

WHO is committed to increasing the use of IPT. Coverage is currently extremely low with only 0.2% of all people with HIV having had access to this therapy last year. Additionally, around the globe just one in 20 HIV-positive people has ever been screened for TB.

“World AIDS Day reminds us that business as usual is unacceptable and HIV programmes need to significantly expand their efforts to address TB,” said Dr Gottfried Hirnschall, Director of WHO’s HIV Department. “We need to fully implement the WHO Three I’s for HIV/TB strategy in collaboration with all partners”.

The Three I’s are: Isoniazid Preventive Therapy, Intensified TB screening and Infection control for TB. According to WHO, these measures should be delivered as part of comprehensive HIV services. 
“In many countries HIV is a major driver of the TB epidemic. TB is preventable and curable and the new guidelines show how to break the chain that links TB and HIV leading to death,” said Dr Mario Raviglione, Director of WHO’s Stop TB Department. “All countries and communities need to implement the new guidelines and WHO can provide the necessary support to ensure that this can happen.”

To encourage access to IPT for the millions in need, the WHO guidelines, which are based on recent scientific evidence used to update 1998 policy, address some of the misconceptions  seen to be partly responsible for the IPT’s low coverage. There is no scientific evidence, for example, to support concerns that the treatment causes drug resistance to isoniazid. Also, IPT can be started following simple clinical screening without the need for costly mandatory tests as had been feared.

There are several key recommendations in the new WHO guidelines:

• All children and adults living with HIV, including those on antiretroviral treatment and pregnant women, should receive IPT.

• IPT should be provided for 6 to 36 months, or as a life-long treatment in settings with high HIV and TB prevalence.

• People living with HIV who may have TB symptoms should befurther screened for active TB or other conditions to enable them to access appropriate treatment.

Preventing people living with HIV from dying of tuberculosis is one of UNAIDS’ priority areas.