Infants aged < 12 months living with HIV who are in contact with a person with TB and who
are unlikely to have active TB on an appropriate clinical evaluation or according to national
guidelines should receive TB preventive treatment.
Adults and adolescents living with HIV who are screened for TB according to a clinical algorithm
and who report any of the symptoms of current cough, fever, weight loss or night sweats may have
active TB and should be evaluated for TB and other diseases and offered preventive treatment
if active TB is excluded.
Children living with HIV who do not have poor weight gain, fever or current cough are unlikely to
have active TB.
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 living with HIV who have an unknown or positive TST status and who are
unlikely to have active TB should receive at least 36 months of IPT. IPT should be given to such
individuals irrespective of the degree of immunosuppression, and also 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.
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.
All people living with HIV with CD4 counts of ≤350 cells/mm3
irrespective of the WHO clinical stage
should start ART.
Children living with HIV who are more than 12 months of age and who are unlikely to have active
TB on symptom-based screening and have no contact with a TB case should receive six months
of IPT (10mg/kg/day) as part of a comprehensive package of HIV prevention and care services.