Candidates for TB Preventive Therapy Among HIV-Infected Persons
A.I Persons with a TST reaction size of greater than or equal to 5 mm who have not previously received treatment for M. tuberculosis infection should receive TB preventive treatment, regardless of their age.

A.II Persons who have had recent contact with an infectious TB patient should receive TB preventive treatment, regardless of their age, results of TSTs, or history of previous TB preventive treatment.

A.II Persons with a history of prior untreated or inadequately treated past TB that healed and no history of adequate treatment for TB should receive TB preventive treatment, regardless of their age or results of TSTs.

C.III Primary prophylaxis for TST-negative, HIV-infected persons with an on-going and unavoidable high risk of exposure to M. tuberculosis for the duration of the exposure time (e.g., residents of prisons, jails, or homeless shelters in which the current prevalence of TB is high) should be considered in some situations.

TB Preventive Therapy Regimens, Including Dosage Recommendations
The following recommendations are appropriate for adults with HIV infection who are likely to have latent M. tuberculosis infection with organisms susceptible to isoniazid and rifamycins. Updated recommendations for children are not yet available. Several TB preventive therapy regimens are currently recommended (Table 3A of Appendix). The TB medications used in these regimens have varying doses, toxicities, and monitoring requirements (Table 2A of Appendix). All patients on twice-a-week dosing regimens should receive DOPT; some experts also recommend DOPT for patients on 2-month preventive therapy regimens. The administration of TB preventive therapy regimens that contain rifampin is contraindicated for patients who take protease inhibitors or NNRTIs. For these patients, the substitution of rifabutin for rifampin in preventive therapy regimens is recommended; however, the substitution of rifapentine for rifampin is not currently recommended because rifapentine's safety and effectiveness have not been established for patients infected with HIV.

Recommended Preventive Therapy Regimens for Patients Receiving Protease Inhibitors or NNRTIs

A.II For HIV-infected adults, a 9-month regimen of isoniazid can be administered daily. B.I For HIV-infected adults, a 9-month regimen of isoniazid can be administered twice a week (DOPT should be used with intermittant dosing regimens).

B.III For HIV-infected adults, a 2-month regimen of rifabutin and pyrazinamide can be administered daily. No rating The concurrent administration of rifabutin is contraindicated with ritonavir, hard-gel saquinavir (Invirase ), and delavirdine.

Recommended Preventive Therapy Regimens for Patients Not Receiving Protease Inhibitors or NNRTIs
A.II For HIV-infected adults, a 9-month regimen of isoniazid can be administered daily.

B.I For HIV-infected adults, a 9-month regimen of isoniazid can be administered twice a week. A.I For HIV-infected adults, a 2-month regimen of rifampin and pyrazinamide can be administered daily.

Duration of TB Preventive Therapy
A.II Daily isoniazid regimens should consist of at least 270 doses to be administered for 9 months or up to 12 months if interruptions in therapy occur.

A.III Twice-a-week isoniazid regimens should consist of at least 76 doses to be administered for 9 months or up to 12 months if interruptions in therapy occur.

A.II Daily regimens of rifamycin (rifampin or rifabutin) and pyrazinamide should consist of at least 60 doses to be administered for 2 months or up to 3 months if interruptions in therapy occur.

A.III When calculating the end-of-preventive-therapy date for individual patients, consider interruptions in therapy because of drug toxicity or other reasons. Completion of therapy is based on total number of medication doses administered and not on duration of therapy alone.

A.III When reinstituting therapy for patients with interrupted TB preventive therapy, clinicians might need to continue the regimen originally prescribed (as long as needed to complete the recommended duration of the particular regimen) or completely renew the entire regimen. In either situation, when therapy is restored after an interruption of greater than or equal to 2 months, a medical examination to rule out TB disease is indicated.

Monthly Monitoring of Patients During TB Preventive Treatment
A.II All persons undergoing preventive treatment for TB should receive a monthly clinical evaluation of their adherence to treatment and medication side effects (see Box 4(Table_B4)). Treatment of Latent M. tuberculosis Infection in Special Situations

A.I DOPT should always be used with intermittent dosing regimens.

B.III DOPT also should be used when operationally feasible, especially with 2-month preventive therapy regimens and in some special settings (e.g., in some institutional settings, in some community outreach programs, and for some persons who are candidates for preventive therapy because they are household contacts of patients with TB disease who are receiving home-based DOT).

A.III For persons who are known to be contacts of patients with isoniazid-resistant, rifamycin-susceptible TB, a 2-month preventive therapy regimen of a rifamycin (rifampin or rifabutin) and pyrazinamide is recommended. For patients with intolerance to pyrazinamide, a 4-6-month regimen of a rifamycin (rifampin or rifabutin) alone is recommended (158-160) (Table 3A of Appendix).

C.III The choices for preventive treatment for persons who are likely to be infected with a strain of M. tuberculosis resistant to both isoniazid and rifamycins are published elsewhere (161). In general, the recommended preventive therapy regimens for these persons include the use of a combination of at least two antituberculosis drugs that the infecting strain is believed to be susceptible to (e.g., ethambutol and pyrazinamide, levofloxacin and ethambutol). The clinician should review the drug-susceptibility pattern of the M. tuberculosis strain isolated from the infecting source-patient before choosing a preventive therapy regimen. A.III For HIV-infected women who are candidates for TB preventive therapy, the initiation or discontinuation of preventive therapy should not be delayed on the basis of pregnancy alone, even during the first trimester. A 9-month regimen of isoniazid administered daily or twice a week is the only recommended option (Table 3A of Appendix). No rating For HIV-infected children who are candidates for TB preventive therapy, a 12-month regimen of isoniazid administered daily is recommended by the American Academy of Pediatrics (162).

Follow-up of HIV-Infected Persons Who Have Completed Preventive Therapy
A.II Follow-up care -- including chest x-rays and medical evaluations -- is not necessary for patients who complete a course of TB preventive treatment, unless they develop symptoms of active TB disease or are subsequently reexposed to a person with infectious TB disease.

Follow-up of HIV-Infected Persons Who Are Candidates for, but Who Do Not Receive, TB Preventive Therapy
A.III These persons should be assessed periodically (in intervals of less than 6 months) for symptoms of active TB as part of their ongoing HIV infection management. Clinicians should educate these persons about the symptoms of TB disease (e.g., cough with or without fever, night sweats, weight loss) and advise them to seek immediate medical attention if they develop such symptoms. If persons present with these symptoms, clinicians should always include TB disease in the differential diagnosis.

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