TB preventive treatment reduces deaths in HIV programs

More than 13 million people living with HIV have received preventive tuberculosis treatment since 2018. Now, data from routine HIV programs in six countries—Haiti, Kenya, Nigeria, Uganda, Ukraine and Zimbabwe—show that the intervention reduced TB and deaths among the people who received it, outside the controlled conditions of a clinical trial.

The study was led by the CDC’s Division of Global HIV and Tuberculosis and Emory University’s Rollins School of Public Health, with findings published in The Lancet HIV. The treatment was mainly six months of isoniazid, a preventive course intended to halt latent TB infection from progressing to active disease. The benefit held across a wide range of country settings, health conditions and risk groups.

Timing mattered. Treatment worked best when started within the first two weeks of entering HIV care, but it remained effective when begun within eight weeks. Newer options available in the United States can be completed in three months or even one month, including for people with HIV.

Concretely, adding TB prevention early in HIV care can reduce two linked harms at once: active tuberculosis and deaths among people with weakened immune systems. That gives clinics a practical window to act, rather than waiting for TB to appear.

The scale of the result is also its limit. These are routine-program findings, not a controlled clinical trial, and the study reports reductions without giving a single effect size in the available account. TB and HIV programs are also facing funding freezes and disruptions; the CDC says reducing TB funding is projected to cause more than half a million additional deaths from TB and increase catastrophic costs for families.