ReacciónPeople living with HIV are about 14 times more likely to develop TB disease, have poorer treatment outcomes and more than two-fold higher mortality during TB treatment, compared to all people diagnosed with TB (1). Addressing HIV-associated TB through integrated patient-centred care and prevention is a key component of the WHO End TB strategy (3).
For several decades, WHO has developed and issued recommendations on screening, diagnosis, treatment, care and prevention of HIV-associated TB. To support countries to reduce the burden of HIV-associated TB in populations at risk of or affected by both diseases, WHO published an Interim policy on collaborative TB/HIV activities in 2004, which was updated in 2012 (9, 10). The TB/HIV policy has served as a vehicle for a robust global response, advocating for further investment and scale-up of collaborative TB/HIV activities, and has provided guidance to Member States and partners on effectively addressing HIV-associated TB. It is estimated that scale-up of these interventions between 2005–2022 has saved 9.2 million lives (1). Yet, despite impressive scale-up of collaborative TB/HIV activities and the advances in the prevention, diagnosis and treatment of TB disease, TB remains the leading cause of death among people living with HIV worldwide and gaps still remain in the implementation of TB/HIV collaborative activities. Since 2012, several recommendations have been updated and additional recommendations formulated as the evidence has evolved.
The guidance provided in this section of the WHO consolidated guidelines on tuberculosis (hereafter referred to as the TB/HIV guidelines) outlines specific WHO recommendations on screening, diagnosis, treatment, care and prevention of HIV-associated TB.
The TB/HIV guidelines contain a set of 31 recommendations on HIV-associated TB, which have been consolidated from WHO guidelines on TB and on HIV, as summarized below. The recommendations are accompanied by operational guidance and implementation considerations in the WHO operational handbook on tuberculosis. Module 6: tuberculosis and comorbidities (7).
Summary of WHO recommendations on HIV-associated TB
These consolidated guidelines summarize the rationale and evidence behind all WHO recommendations that address HIV-associated TB for adults living with HIV although some recommendations will also be relevant for children and adolescents.1 Recommendations specifically related to HIV-associated TB in children and adolescents can be found in the WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents (11). Other WHO recommendations on TB screening, diagnosis, treatment and care for all people with TB regardless of HIV status are available in the respective modules of the WHO consolidated guidelines on tuberculosis that can be found on the WHO TB Knowledge Sharing Platform (12-19). The WHO recommendations to reduce the burden of TB among people living with HIV and conversely, to reduce the burden of HIV among people with TB, are listed below. A summary of changes to recommendations published in the 2012 WHO policy on collaborative TB/HIV activities (10) is provided in Annex 2.
Reduce the burden of TB among people with HIV
Reduce the burden of HIV among people with TB
1 Updates to recommendations can be found on the TB knowledge sharing platform (https://tbksp.org/) and on the WHO HIV/AIDS knowledge sharing platform (https://www.who.int/health-topics/hiv-aids).
