TB preventive treatment cuts deaths in HIV patients across six countries

Tuberculosis kills more people with HIV than any other single cause. In 2024, it accounted for roughly a quarter of all AIDS deaths worldwide, and it remains the leading infectious disease killer on the planet. Yet tuberculosis is preventable. It is treatable. The gap between what medicine can do and what actually happens in clinics across the developing world has long been the real problem.

That gap is narrowing. A study published this week in The Lancet HIV, led by the Centers for Disease Control and Prevention and Emory University's Rollins School of Public Health, tracked what happens when countries actually deliver tuberculosis preventive treatment at scale. The researchers examined six nations with particularly high burdens of both diseases—Haiti, Kenya, Nigeria, Uganda, Ukraine, and Zimbabwe—and found something straightforward and powerful: the treatment works in the real world, not just in controlled trials. When people with HIV received TB preventive therapy, primarily a six-month course of isoniazid, tuberculosis cases dropped and deaths fell. The effect held across different health systems, different patient populations, and different risk groups.

The timing matters. Starting TB preventive treatment within the first two weeks of entering HIV care produces the best results, but the treatment remains effective even when begun within eight weeks. This is crucial information for programs trying to coordinate care across multiple conditions. It means there is a window—not infinitely wide, but real—in which to act.

The scale of this intervention has already been substantial. Since 2018, when the U.S. President's Emergency Plan for AIDS Relief made a major commitment to TB preventive treatment, more than 13 million people living with HIV worldwide have received the therapy. That represents a shift from the slow, fragmented implementation that followed earlier clinical trials. "What is powerful about these findings," said Anand Date, chief of the CDC's Global TB Branch, "is that they come from routine HIV programs, not from a controlled clinical trial. This is program data showing what happens when countries deliver TB preventive treatment at scale."

The global context is sobering. In 2024 alone, more than 10.7 million people fell ill with tuberculosis, and 1.2 million died from it. The disease appears in every country on Earth, including all 50 U.S. states. An estimated 13 million Americans carry latent TB infection—a dormant form that can progress to active disease, particularly in people with weakened immune systems. Newer treatment regimens, available in the United States and increasingly elsewhere, can be completed in as little as one month, making prevention more feasible than ever.

But the gains are fragile. Over the past year, U.S. foreign aid has faced freezes, USAID has been dissolved, and PEPFAR funding has been disrupted. These are not abstract budget cuts. Researchers project that reducing funding for TB programs will result in more than half a million additional deaths from tuberculosis and impose catastrophic costs on families already struggling with illness. "This is important in the current context of reduced funding for global health programs," said Sarita Shah, a professor of epidemiology and global health at Rollins, "to ensure that gains made in HIV care over the last two decades are sustained." The study offers evidence that TB preventive treatment belongs at the center of HIV care. Whether that evidence will be enough to protect the programs that deliver it remains an open question.