Tuberculosis Preventive Therapy (TPT)

Z29.2 + (B24)

Patients with HIV infection are more susceptible to TB infection than HIV-uninfected patients at any CD4 count. TPT is an effective intervention for reducing the incidence of TB in HIV-infected patients

Eligibility

All HIV-infected patients, irrespective of CD4 count and ART status.

Exclusions

  • Suspected or confirmed TB
  • Painful peripheral neuropathy
  • Liver Disease
  • Alcohol abusers
  • Previous MDR- or XDR-TB

Note:

  • TB must be excluded prior to initiating TPT by screening for the following:
    • Cough (any duration)
    • Weight loss
    • Fever
    • Night sweats
  • TPT should not be initiated in patients if any of the above is present. These patients require further investigation for active TB.

Start TPT together with ARVs:

  • Isoniazid, oral, 300 mg daily for 12 months.

AND

  • Pyridoxine, oral, 25 mg once daily for 12 months.
    • Educate patients on the symptoms of hepatotoxicity (nausea, vomiting, yellow eyes, brown urine, and pain in right upper quadrant).
    • Instruct patient to present early if any of these symptoms arise.
    • Patients should be followed up monthly for the first 3 months.

LoEI [25]

In pregnant women, starting ART:
If CD4 >350 cells/mm3.
  • Defer TPT until after delivery.
    		•  If CD4 ≤350 cells/mm3.
  • Exclude active TB with symptom screen and TB Xpert MTB/RIF Ultra ®, then give TPT.



    • LoEII [26]