NHS临床指南 Three Is for HIVTB WHO 2011 guidelines for ICFIPTPPT.ppt

Footnotes to algorithm for children * All children and infants less than one year of age should be provided with IPT if they have a history of household contact with a TB case. ** Poor weight gain is defined as reported weight loss, or very low weight (weight-for-age less than –3 z-score), or underweight (weight-for-age less than –2 z-score), or confirmed weight loss (5%) since the last visit, or growth curve flattening. *** Contraindications include: active hepatitis (acute or chronic) and symptoms of peripheral neuropathy. Past history of TB should not be a contraindication for starting IPT. Although not a requirement for initiating IPT, TST may be done as a part of eligibility screening in some settings. **** Investigations for TB must be done in accordance with existing national guidelines. For confirmed, probable or possible TB, preventive chemotherapy reduces the overall risk of developing TB by 33% (relative effect 0.67; CI 0.51-0.87). For TST positives the reduction of confirmed, probable or possible TB increased to 64% [RR (CI 95%) 0.36 (0.22-0.61)] Although not statistically significant, the reduction among TST negatives was 14% [RR (CI 95%) 0.86 (0.59, 1.26)] and in unknown TST 14% [RR (CI 95%) 0.86 (0.48, 1.52) [15]. The guideline group concluded that there is benefit of TB preventive therapy for people living with HIV regardless of TST status, with increased protective benefit seen in those with a positive tuberculin skin test. The guideline group reviewed emerging unpublished evidence from two clinical trials that suggest increased benefit with 36 months or longer duration of IPT, particularly in people who are TST positives. Given that longer trials are costly and unlikely to be done, the guideline group considered at least 36 months duration as a surrogate for lifelong treatment. The guidelines group emphasized the potential benefit of extended IPT for people living with HIV in settings with a background of higher HIV and TB prevalen