Approach to timing of treatment for tuberculosis infection (latent tuberculosis) in pregnant patients with HIV infection in settings with TB transmission rates <500 per 100,000*

TB: tuberculosis; HIV: human immunodeficiency virus; TST: tuberculin skin test; IGRA: interferon-gamma release assay; ART: antiretroviral therapy.

* Tuberculosis terminology is inconsistent in the literature. TB infection (used here) is a newer term for latent tuberculosis infection; TB disease (used here) is a newer term for active tuberculosis.

¶ Testing asymptomatic patients for TB infection during pregnancy is warranted for patients with significant risk factors for TB and progression to TB disease during pregnancy; refer to the UpToDate topic on tuberculosis infection in pregnancy for further discussion.

Δ Patients not on ART warrant prompt initiation of ART, to reduce the risk of progression from latent tuberculosis infection to TB disease.

◊ Our approach is in alignment with the United States Department of Health and Human Services (DHHS) guidelines^[1]. This approach differs from the World Health Organization 2020 statement, which favors treatment of TB infection during pregnancy^[2].