After ruling out TB disease through a medical evaluation, which contacts should be considered for prophylactic treatment even if they have a negative test for TB infection?

• A. Healthy adults
• B. College students
• C. Persons living with HIV/AIDS
• D. Children between five and 12 years of age

Answer: (C)

People with HIV/AIDS have a much higher risk of latent TB reactivating and developing active TB, even if their TB infection test is negative. Immune suppression can cause anergy, meaning the test won’t reliably show latent infection. Once active TB disease has been ruled out clinically and radiographically, starting preventive therapy for latent TB is advised for people living with HIV to prevent progression and reduce transmission risk.

Healthy adults and college students generally don’t require prophylaxis based on a negative test alone because their risk of progression is much lower and a negative test is more reliable. Children in the 5–12 age range are also a concern after exposure, but the strongest, most consistent indication for prophylaxis despite a negative test is HIV infection due to the high progression risk from latent to active TB in that group.