Preventing tuberculosis in people with HIV—no more excuses

In 2014, tuberculosis eclipsed HIV as the leading infectious killer on earth and it remains the foremost cause of death for people with HIV infection. The risk of tuberculosis doubles after HIV is acquired, skyrockets with falling CD4 counts, and remains substantially elevated even after immune reconstitution with antiretroviral therapy (ART). From the earliest days of the HIV epidemic, it was evident that preventive therapy with isoniazid—a cheap, widely available, well-tolerated drug that has been around for more than 60 years—was protective against tuberculosis in people with HIV infection, and WHO recommended its use as a personal health measure (ie, not as a programmatic imperative) in 1993.