TB Preventive Treatment for HIV Effective in Real-world Settings

Real-world Program Impact

The study evaluated the implementation of TB preventive treatment—primarily using a six-month course of isoniazid—across diverse health conditions and risk groups. Findings confirmed that providing this preventative care significantly lowered the occurrence of TB and reduced deaths among people living with HIV.

What is powerful about these findings is that they come from routine HIV programs, not from a controlled clinical trial, said Anand Date, chief of the CDC’s Global TB Branch. This is program data showing what happens when countries deliver TB preventive treatment at scale.

The data indicates that the timing of the intervention is a critical factor for success. While the treatment is effective when initiated within eight weeks of a patient entering HIV care, researchers identified that starting within the first two weeks is ideal. Experts emphasize that integrating these preventative measures into existing HIV care programs is essential for sustaining the health gains achieved over the last two decades.

Context of the Global TB Crisis

TB remains a significant global health threat, acting as the leading cause of infectious disease death worldwide. In 2024, more than 10.7 million people were infected with TB, and 1.2 million people died from the disease. For individuals living with HIV, the risk is particularly acute, as TB is responsible for approximately one-quarter of all AIDS-related deaths and served as the leading cause of death among people with HIV in 2024.

Since a major commitment by the U.S. Sarita Shah, a professor of epidemiology and global health at Rollins, noted that the findings underscore the importance of TB prevention, especially in the current climate of constrained global health funding.

Advancements in Drug-Resistant TB Treatment

Beyond preventative care, progress is also being made in treating active, drug-resistant forms of the disease. A separate prospective cohort study reported in Clinical Infectious Diseases found that six-month, all-oral treatment regimens recommended by the World Health Organization (WHO) achieved high success rates in non-clinical trial settings.

The study, which tracked patients in Belarus and Uzbekistan between February 2022 and June 2023, focused on BPaL-based regimens—a combination of bedaquiline, pretomanid, and linezolid. Among 667 patients with multidrug-resistant or pre-extensively drug-resistant TB, 93.6% achieved a successful treatment outcome. These results mirror the high efficacy rates observed in phase 3 clinical trials, such as the TB-PRACTECAL, Nix-TB, and ZeNix studies.

Technological Support for Clinical Care

To further assist in clinical decision-making, researchers at the University of Melbourne’s Doherty Institute have developed an open-access genomic software tool known as tbtAMR. Detailed in The Lancet Digital Health, the tool is designed for use in frontline clinical laboratories, including those in low-resource settings that may lack dedicated bioinformatics expertise.

By analyzing standard sequencing files, tbtAMR can detect genetic changes associated with antibiotic resistance and rapidly identify which drugs are most likely to be effective for a specific patient.

Free and public access to tbAMR allows laboratories worldwide, particularly those in low- and middle-income countries, to easily analyse TB genomic data, with outputs that are ready to report back to clinicians to guide optimal patient management, said Associate Professor Norelle Sherry, senior author of the paper. This tool aims to strengthen antibiotic stewardship and support more targeted, timely treatment for patients globally.