title: New vaccines for the prevention of tuberculosis in human immunodeficiency virus infection.
abstract: The prevention of human immunodeficiency virus (HIV) associated tuberculosis (TB) remains challenging. Several vaccines against TB have advanced to clinical trials in patients with HIV infection. The DarDar Trial, a large, randomized, placebo-controlled efficacy trial conducted in Tanzania,  has demonstrated that a multiple dose series of an inactivated whole cell mycobacterial vaccine is safe in HIV and can prevent HIV-associated TB in patients with childhood bacille Calmette-Guérin vaccination and CD4 counts of ≥200 cells/mm(3). These developments offer promise  that in the not too distant future immunization with an effective vaccine against TB can be added to other strategies for the prevention of HIV-associated TB. This expanded approach is referred to as the Five 'I's': intensified case finding, infection control, isoniazid preventive  therapy (IPT), initiation of antiretroviral therapy (ART), and immunization against TB. We encourage additional studies of new TB vaccines in HIV, and propose a strategy to reduce the risk of TB by integrating IPT, ART and immunization into routine HIV care. At the time of HIV diagnosis, patients  with CD4 counts of ≥200 cells/mm(3) could receive immunization, IPT and, as appropriate, ART. In patients presenting with lower CD4 counts or already on ART, immunization could be initiated at CD4 counts of ≥200 cells/mm(3) to add to the protection afforded by IPT and  ART.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. fvr@dartmouth.edu
authors.forename: C F
authors.initials: CF
authors.lastname: von Reyn
authors.forename: M
authors.initials: M
authors.lastname: Bakari
authors.forename: R D
authors.initials: RD
authors.lastname: Arbeit
authors.forename: T
authors.initials: T
authors.lastname: Lahey
authors.forename: A
authors.initials: A
authors.lastname: Ramadhani
authors.forename: S
authors.initials: S
authors.lastname: Egwaga
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D019033:Delivery of Health Care, Integrated; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D011314:Preventive Health Services; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*; D032581:Tuberculosis Vaccines
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D032581:Tuberculosis Vaccines; D007538:Isoniazid