WHO releases updated guidelines to effectively reduce TB deaths among HIV-infected

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The World Health Organization released updated guidance Friday with updated global policy for prevention, diagnosis and treatment of both HIV and tuberculosis (TB).

The WHO released initial guidance in 2004 – and in the past six years approximately 910,000 lives have been saved worldwide thanks to improved collaboration between HIV and TB services, protecting people with HIV from contracting TB, according to a WHO note to the media. The number of people with HIV screened for TB increased from nearly 200,000 in 2005 to more than 2.3 million people in 2010, and the number of TB patients tested for HIV was boosted similarly from 470,000 to more than 2.2 million in the same time frame.

TB remains the number one killer of people living with HIV in sub-Saharan Africa.

“This framework is the international standard for the prevention, care and treatment of TB and HIV patients to reduce deaths; and we have strong evidence that it works,” said Dr. Mario Raviglione, director of the WHO Stop TB Department in the release. Policymakers, HIV and TB experts, program managers, donor organizations and civil society organizations including people living with HIV participated in the WHO group that updated the guidance, which is meant to further reduce deaths from both conditions with accelerated coordination of public health interventions.

“Now is the time to build on these actions and break the chain that links TB and HIV with death for so many people,” Raviglione said.

Experts will brief an audience at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle Monday on the new HIV/TB policy, the main elements of which include:

  • routine HIV testing for TB patients, people with symptoms of TB, and their partners or family members;
  • provision of co-trimoxazole, a cost-effective medicine to prevent against lung or other infections, for all TB patients who are infected with HIV;
  • starting all TB patients with HIV on antiretroviral therapy (ART) as soon as possible (and within the first two weeks of starting anti-TB treatment) regardless of their CD4 cell counts; and
  • evidence-based methods to prevent the acquisition of HIV for TB patients, their families and communities.

“To continue the progress and save more lives, comprehensive HIV services must include the Three I’s for HIV/TB strategy: isoniazid preventive therapy, intensified screening and infection control for TB, and it should also include earlier treatment for HIV for those that are eligible,” said Dr Gottfried Hirnschall, director of WHO’s HIV/AIDS Department, in the release.

Other noted differences in the updated guidance include an emphasis on “the need to establish mechanisms for delivering integrated TB and HIV services, preferably at the same time and location,” according to the guidelines executive summary. The guidance also encourages HIV and TB-control programs to collaborate with other programs, “to ensure access to integrated and quality-assured services for women, children, prisoners and for people who use drugs; this population should also receive harm-reduction services including drug dependence treatment in in-patient and out-patient settings.

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