Preventive therapy for tuberculosis in HIV-infected persons: international recommendations, research, and practice

Abstract

The World Health Organization estimates that more than four million people worldwide are infected with both Mycobacterium tuberculosis and HIV. HIV infection is the strongest known risk factor for the development of tuberculosis (TB). Mechanisms for the development of active TB include the reactivation of latent infection, rapid progression in primary infection, and/or reinfection with Mycobacterium tuberculosis. Indeed, HIV-infected people with a positive tuberculin skin test have a 5-8% annual risk and a 30% or greater lifetime risk of developing TB. Case-finding and treatment, preventive therapy, the use of BCG, and environmental measures can, however, control TB. Emphasis in developing countries has been upon case-finding and treatment, and providing infants with BCG. Preventive therapy has not been recommended except for breastfeeding infants of mothers with pulmonary TB or other children under five years old living with infectious persons. The high incidence of TB in HIV-infected people in developing countries has, however, led to reconsideration of the role of preventive therapy as a public health strategy. The authors briefly discuss preventive therapy for TB in HIV-infected persons, research issues, and the international role of preventive therapy.