strong

Providing IPT to people living with HIV does not increase the risk of developing isoniazid-resistant
TB. Therefore, concerns regarding the development of INH resistance should not be a barrier to
providing IPT.

Tuberculin skin test (TST) is not a requirement for initiating IPT in people living with HIV (strong
recommendation, moderate quality of evidence). People living with HIV who have a positive
TST benefit more from IPT; TST can be used where feasible to identify such individuals.

Adults and adolescents who are living with HIV, have unknown or positive tuberculin skin test
(TST) status and are unlikely to have active TB should receive at least 6 months of IPT as part of
a comprehensive package of HIV care. IPT should be given to such individuals irrespective of the
degree of immunosuppression, and also to those on ART, those who have previously been treated
for TB and pregnant women.

Adults and adolescents living with HIV should be screened with a clinical algorithm; those who
do not report any one of the symptoms of current cough, fever, weight loss or night sweats are
unlikely to have active TB and should be offered IPT.

TB patients with known positive HIV status and TB patients living in HIV-prevalent settings should
receive at least 6 months of rifampicin treatment regimen (strong recommendation, high-quality
of evidence). The optimal dosing frequency is daily during the intensive and continuation phases.

Children living with HIV who have any of the following symptoms – poor weight gain, fever or
current cough or contact history with a TB case – may have TB and should be evaluated for TB and
other conditions. If the evaluation shows no TB, children should be offered IPT regardless of their
age.

Efavirenz should be used as the preferred non-nucleoside reverse transcriptase inhibitor in patients
starting ART while on antituberculosis treatment.

Antituberculosis treatment should be initiated first, followed by ART as soon as possible within the
first 8 weeks of treatment. Those HIV positive TB patients with profound immunosuppression (e.g. CD4 counts less than 50 cells cells/ mm3) should receive ART immediately within the first 2 weeks of initiating TB treatment.

ART should be started in all TB patients living with HIV irrespective of their CD4 counts.

Routine co-trimoxazole preventive therapy should be administered in all HIV-infected patients with
active TB disease regardless of CD4 counts.