Access and adherence to isoniazid preventive therapy and occurrence of active TB in a cohort of people living with HIV: a retrospective cohort study in Sao Paulo, Brazil

Abstract

Tuberculosis (TB) is still a leading cause of morbidity and mortality among people living with HIV (PLHIV). The diagnosis of latent TB is required for the implementation of prophylactic therapy with isoniazid (PTI). However, low access to diagnosis of latent TB and non-adherence to PTI may hinder potential benefits of this essential intervention. In this study, we addressed the access and adherence to PTI in a cohort of PLHIV with positive tuberculin skin test (TST) in a reference HIV clinic in Sao Paulo, Brazil. We have also analyzed the occurrence of active TB over a median of 131 months after a positive TST among study participants. Our findings revealed that 88.3% of the 238 TST-positive patients had access to PTI, and 196 (93.3%) of those with access adhered to PTI. Active tuberculosis was diagnosed in three of the 196 TST-positive patients who adhered to PTI (1.5%; 95% confidence interval [CI] 0.3-4.4%), whereas seven cases were detected among 42 patients without access or who did not adhere to PTI (16.6%; 95% CI 7.0-31.3%). The apparent beneficial effect of PTI in our cohort is consistent with previous studies including PLHIV, and highlights the importance of reliably delivering each of the steps between screening for latent TB and provision of PTI.

Latent tuberculosis infection therapy in people living with human immunodeficiency virus infection

“…Primary outcomes Isoniazid vs. placebo or non-treatment Two NRSs compared the e cacy between isoniazid and non-treatment in 470 participants. The e cacy was similar in the two groups (OR: 0.62; 95%CI 0.17-2.26) (19,20). However, most active TB patients in isoniazid group in Picone et al's study were non-adherent to therapy (6 of the 14 non-adherent patients suffered active tuberculosis).…”

“…In one trial, the non-treatment group being compared with the isoniazid group had variable "literacy" and "illicit drug use", and the adherence to isoniazid was self-reported (19). The reason why patients didn't receive prophylactic therapy in the other studies is not clear, however some patients with liver disease have concerns regarding the safety of isoniazid (20).…”

Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review

“…Three of the included studies did not report where they were conducted 54 , 62 , 88 . The most frequent settings were: outpatient clinics and clinics (n = 41) 24 - 26 , 30 , 35 - 38 , 40 - 43 , 46 - 52 , 56 - 58 , 61 , 67 , 68 , 71 - 73 , 75 , 81 , 82 , 84 , 85 , 87 , 89 - 95 ; hospitals (n =19) 24 , 28 , 39 , 40 , 45 , 53 , 55 , 59 , 60 , 64 , 66 , 70 , 74 , 76 , 77 , 80 , 78 , 79 , 83 ; and penitentiaries (n = 4) 29 , 31 , 33 , 63 .…”

“…Most of the included studies (n = 49) did not specify patient profiles 24 - 33 , 35 - 37 , 40 - 44 , 47 , 49 , 51 , 52 , 54 , 55 , 57 - 59 , 60 , 63 - 65 , 67 , 68 , 70 , 71 , 77 , 79 , 81 - 87 , 89 , 90 , 93 , 94 , four studies involved patients with inflammatory bowel disease or immune-mediated inflammatory diseases 72 , 73 , 76 , 80 , four involved human immunodeficiency virus (HIV)-positive adults 56 , 61 , 74 , 91 , four involved patients who transplanted or had transplants 34 , 50 , 62 , 66 , and six involved health professionals 38 , 39 , 45 , 48 , 78 , 88 .…”

Examination of Surgically Important Healthy Life Expectancy and Respiratory Tract Deaths: The Relationship between Tuberculosis-Related Deaths and Health Adjusted Life Expectancy (HALE)

“…In TB cases caused by M. tuberclosis mycrobacteria in the past, with the development and use of antimicrobials, mortality rates decreased significantly and TB ceased to be an important public health. However, as a result of the development of multi drug resistant TB and extensive drug resistant TB and the increase of immune system disrupting diseases such as HIV, TB has become one of the most important global health problems and deaths caused by infections [17][18][19][20] . In our study, according to WHO ICD-10 data, it was observed that tuberculosis-related deaths were reported in 14 countries in the world, of which 12 countries had tuberculosis-related deaths over a year.…”