Latent M. tuberculosis Infection Clinical and Public Health Principles
When caring for persons with HIV infection, clinicians should make aggressive efforts to identify those who also are infected with M. tuberculosis. Because the reliability of the tuberculin skin test (TST) can diminish as the CD4+ T-cell count declines, TB screening with TST should be performed as soon as possible after HIV infection is diagnosed. Because the risk of infection and disease with M. tuberculosis is particularly high among HIV-infected contacts of persons with infectious pulmonary or laryngeal TB, these persons must be evaluated for TB as soon as possible after learning of exposure to a patient with infectious TB.

Health-care providers, administrators, and TB controllers must coordinate their work and establish TB screening initiatives in settings where a) the prevalence of infection with M. tuberculosis among persons with HIV-infection is expected to be high and b) referral for medical evaluation and TB preventive therapy can be accomplished. Such settings include prisons, jails, prenatal-care programs, drug treatment programs, syringe exchange programs, HIV specialty clinics, acute-care hospitals serving populations at high risk of TB, AIDS patient group residences, some community-health centers, psychiatric institutions, mental health residences, and homeless shelters. All HIV counseling and testing sites must have mechanisms in place to ensure that persons identified with HIV infection receive tuberculin skin testing. TB control programs in jurisdictions that have HIV reporting requirements should make efforts to ensure that all persons with HIV infection have TSTs.

Because of the complexity of problems associated with active TB disease in HIV-infected persons, and as part of the efforts to control and eliminate TB in the United States, all HIV-infected persons identified as latently infected with M. tuberculosis should complete a full recommended course of preventive therapy unless such therapy is contraindicated. Public health programs should take an active role in ensuring that patients treated in outpatient settings complete TB preventive therapy. In certain outpatient and institutional settings, directly observed preventive therapy (DOPT) should be used whenever operationally feasible and when resources permit.

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