Tuberculosis (TB) remains the leading cause of death in people living with HIV (PLHIV) despite the achievements in antiretroviral therapy coverage. TB preventive therapy (TPT) has proved efficacy but has been neglected and poorly implemented. We reviewed recent publications and guidelines about TPT in PLHIV.
High-quality studies showed that TPT has a durable effect, over 5 years, preventing TB and all-cause mortality. There is new evidence showing the noninferiority of shorter, rifamycin-based regimens of TPT increasing the options for treatment. Recent studies describing robust implementation in different settings showed promising results for feasibility, tolerance, retention, and cost-effectiveness. New WHO recommendations, unifying previous versions, have been released to guide countries implementation.
New evidence support the scale up of TPT for PLHIV globally, further studies are needed to bring more evidence for specific populations, like pregnant women and for drug–drug interactions with antiretroviral agents.
aCenter for Strategic Studies, Fiocruz and Instituto de Doenças do Torax Federal University of Rio de Janeiro, UFRJ
bEvandro Chagas National Institute of Infectious Diseases – Fiocruz, Rio de Janeiro, Brazil
Correspondence to Betina Durovni, MD, PhD, Center for Strategic Studies, Fiocruz and Federal University of Rio de Janeiro, UFRJ, Av. Brasil, 4036 – Prédio da Expansão – 10 Andar – Manguinhos, 21040-361 Rio de Janeiro, RJ, Brazil. E-mail: firstname.lastname@example.org