Vaccination

Until 2005 schoolchildren in the UK and most other European countries, were given a BCG vaccination against TB. However, this vaccination does not offer complete protection against TB, and there have been many cases of people who received the BCG jab as a child developing TB. Since 2005 the UK has had a policy of targeting use of this vaccine. Those recommended for vaccination include:

• All children living in areas where there is a lot of TB.
• Children whose parents or grandparents were born in countries where there is a lot of TB.
• Recent immigrants from countries where there is a lot of TB.

People with HIV should not be given the BCG jab as it is a live vaccine and can cause a TB-like illness.

Preventing TB - Improving the immune system with HIV treatment

One of the best ways of preventing TB in people with HIV is to improve the immune system. Treatment with combinations of effective anti-HIV drugs boosts the immune system, enabling it to fight TB and other infections.

Preventing TB - Taking anti-TB drugs (prophylaxis)

People with latent TB, or people who have been in close contact with people who have TB, are sometimes given an anti-TB drug or drugs to prevent the TB becoming active. The drug normally used is called isoniazid, which is given for at least six months. Combinations of rifampicin and isoniazid can be given for four months. It is recommended that HIV-positive people who come from communities that have high levels of TB, including people from Africa and those from the Indian sub-continent, are given this treatment if PPD-positive. It is also recommended that HIV-positive people who have been in close contact with people with active TB should receive this treatment.

However, there are concerns about the safety of this approach, as it could lead to the development of drug-resistant TB if the latent TB is really active TB that has not been correctly diagnosed. Also, isoniazid can cause side-effects and interact with some anti-HIV medicines, particularly ddI (didanosine, Videx) and d4T (stavudine, Zerit).

Isoniazid can also be harmful to the liver, and you will be to have your liver's function monitored closely for as long as you are taking isoniazid.

Helping yourself

Eating well, getting an adequate amount of sleep and living in dry, well ventilated housing will help you avoid infection with TB or stay well if you have been exposed to it or have latent TB. The booklet Nutrition, which is also produced by NAM in this series, gives some tips on healthy eating. If you cannot afford to eat properly or have housing problems it is important that you seek help. Talk to your clinic about and try contacting THT Direct whose contact details are provided at the back of this booklet. They should be able to put you into contact with somebody who can provide you with advice, help and information.

If you come into contact with somebody with TB, such as a family member, housemate or friend, then you should go to your HIV clinic as soon as possible for tests to see if you have been infected.