Optimising Tuberculosis preventive therapy for persons with HIV

Tuberculosis (TB) continues to be common comorbidity among persons with HIV, particularly in high-burden countries. While preventive therapy reduces the risk for TB, worldwide adoption and scale-up have been poor. In a study conducted in three African countries, investigators randomised participants to one of three groups: weekly rifapentine and isoniazid for three months, given annually for two years or given once, or six months of daily isoniazid.

TB preventive therapy represents a useful strategy to lower risk for active TB among persons with HIV; however, its global uptake has been suboptimal, in part because of potential recipients' concerns that their risk for TB will return to baseline after completion of treatment. In this study among persons with HIV on antiretroviral therapy, a short course of weekly rifapentine–isoniazid had better completion rates than daily isoniazid (although repeating the weekly treatment a year later provided no further benefit).

These encouraging findings should trigger advances in guidelines and practice. Unfortunately, rifapentine remains unavailable in most of the world — a situation that must be rectified before such advances can become reality.