Bibliographic Info
GuidelineGuidelines: updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring
Year of Publication2021
Issuing InstitutionWHO
Recommendation
Status
Updated
Among people living with HIV with signs and symptoms suggesting TB, except for central nervous system disease (meningitis), initiate ART while rapidly investigating for TB, with close follow-up within seven days to initiate TB treatment if TB is confirmed.
Notes and Remarks
- 1.The earlier clinical consideration was informed by expert opinion that a brief delay in ART initiation might be beneficial – on reviewing evidence from the systematic review and prevailing practices in countries, the Guideline Development Group agreed that initiating ART was a priority and that TB symptoms may be evaluated simultaneously while initiating ART rapidly. 2. Close follow-up is required to ensure that TB diagnostic results are acted on rapidly and that immune reconstitution inflammatory syndrome and other adverse events are recognized and managed across populations. HIV programmes must also ensure adequate training of health-care personnel to recognize TB signs and symptoms among vulnerable people such as infants and children, rule out central nervous system signs and symptoms and assess for and manage both advanced HIV disease and locally endemic coinfections (16). Ensuring the availability of rapid diagnostic tests for TB and systems for timely return of results (ideally same-day return if feasible) is also important. Patient education and support for early recognition of immune reconstitution inflammatory syndrome, adverse events and adherence counselling are needed. Improvements in case-based surveillance systems are required to identify those who are lost to follow-up and who experience adverse events and immune reconstitution inflammatory syndrome.