Tuberculosis (TB) is responsible for about a quarter of all AIDS deaths. In 2024, it was also the leading cause of death among people with HIV. This is despite TB being a preventable and curable disease.
Although clinical trials have shown the benefit of TB preventive treatment in people with HIV, implementation in program settings was slow until a major commitment by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in 2018. Since then, over 13 million people living with HIV worldwide have received TB preventive treatment.
A new study led by the Centers for Disease Control and Prevention's Division of Global HIV and Tuberculosis and Emory University's Rollins School of Public Health evaluated the real-world impact of TB preventive treatment in six countries with high TB and HIV rates (Haiti, Kenya, Nigeria, Uganda, Ukraine, and Zimbabwe). Findings were published today in The Lancet HIV .
What They Found
- TB preventive treatment works in real-world settings. Providing TB preventive treatment, mainly with 6 months of isoniazid, lowered the occurrence of TB and deaths in people who received the treatment. This was true across a wide range of country settings, health conditions, and risk groups.
- TB preventive treatment works best when it is started early in HIV care. Within the first two weeks is ideal but it is still effective when started within eight weeks of entering HIV care.
- Advancements in HIV detection, treatment, and care should go hand in hand with TB preventive treatment as a vital aspect of HIV programs.
"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 CDC's Global TB Branch. "This is program data showing what happens when countries deliver TB preventive treatment at scale."
TB and HIV Prevention at a Global Level
TB is the leading cause of infectious disease death in the world. More than 10.7 million people were sick with TB and 1.2 million people died from it in 2024. Anyone can get TB, and certain groups are more vulnerable to the disease than others, including older adults, children, and people with weakened immune systems (such as those with HIV or cancer).
The highly contagious infectious disease appears in every country in the world, including the United States, where it occurs in all 50 states .
- An estimated 13 million Americans are living with latent TB infection, representing the reservoir of possible future active TB disease.
- TB preventive treatment when taken correctly can halt the progression to active TB disease.
- Newer treatment options in the U.S. are shorter and can be completed in three months or even one month, including for people with HIV.
Global HIV and TB prevention and treatment efforts have faced setbacks in the past year with freezes on U.S. foreign aid, the dissolution of USAID, and disruptions to PEPFAR funding. Reducing funding for TB programs is projected to result in more than half a million additional deaths from TB and increased catastrophic costs for families.
"Taken together, the findings support the critical role of tuberculosis preventive treatment in HIV care programs," says Sarita Shah, MD, MPH , professor of epidemiology and global health at Rollins. "This is important in the current context of reduced funding for global health programs to ensure that gains made in HIV care over the last two decades are sustained."
