Isoniazid Preventive Therapy and Risk for Resistant Tuberculosis

Balcells, María Elvira; Thomas, Sara L; Godfrey‐Faussett, Peter; Grant, Alison D.

doi:10.3201/eid1205.050681

Cited by 205 publications

(150 citation statements)

References 34 publications

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“…In the Nairobi trial, the rate of resistance in the isoniazid arm was not statistically different from the rate in HIV-positive individuals in Kenya (5). More generally, a systematic review of IPT trials which assessed the risk of acquired resistance as a result of IPT (38), while not excluding the possibility of an increased risk, found no statistically significant relationship between isoniazid resistance and completion of IPT.…”

Section: Discussionmentioning

confidence: 99%

Ability of preventive therapy to cure latent Mycobacterium tuberculosis infection in HIV-infected individuals in high-burden settings

Houben¹,

Sumner²,

Grant

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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Trials of isoniazid preventive therapy (IPT) for people living with HIV in southern Africa have shown high rates of tuberculosis disease immediately after cessation of therapy. This could be due to the lack of cure following preventive therapy or reinfection with rapid progression to disease. Using a model fitted to trial data, we estimate the degree to which preventive therapies cure latent Mycobacterium tuberculosis infection in HIV-infected individuals in high-tuberculosis-burden settings. We identified randomized controlled trials that compared IPT to placebo or alternative regimen in HIV-positive, tuberculin skin test positive individuals. A mathematical model describing tuberculosis transmission in a closed cohort of HIV-positive, M. tuberculosis infected, antiretroviral therapy naive individuals following completion of preventive therapy (or placebo) was fitted to posttherapy tuberculosis rates to estimate the annual risk of M. tuberculosis reinfection and the proportion of individuals whose latent infection was cured after therapy. Three trials met our inclusion criteria. Estimated annual risks of reinfection ranged between 3.7 and 4.9%. Our results suggest 6 mo of isoniazid cured in a small proportion [estimated proportion cured = 0% (interquartile range 0-30.9%)]. The proportion cured for 3-mo regimens containing rifampicin or rifapentine was 19-100%. IPT alone does not cure existing infections in the majority of HIV-infected individuals. In high-incidence settings, continuous IPT should be integrated with HIV care. Where the risk of reinfection is lower, preventive therapy with more curative drugs should be preferred for HIV-positive individuals to achieve durable patient benefit.

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Section: Discussionmentioning

confidence: 99%

Ability of preventive therapy to cure latent Mycobacterium tuberculosis infection in HIV-infected individuals in high-burden settings

Houben¹,

Sumner²,

Grant

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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“…A systematic review of studies of IPT conducted between 1951 and 2005 concluded that IPT was not associated with an increased risk of isoniazid resistance and that isoniazid resistance is much more likely to result from inadequate treatment of active disease. [45] The studies of cIPT in Botswana and SA did not show an increased risk of isoniazid resistance. [31,34] Among 126 goldminers with TB after starting IPT, the prevalence of isoniazid resistance and treatment outcomes were similar to those in TB cases without previous exposure to IPT.…”

Section: Isoniazid Resistancementioning

confidence: 96%

Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control

et al. 2014

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“…Estudios previos han demostrado cómo la profilaxis mejora la supervivencia de los pacientes coinfectados con VIH/tuberculosis, de hasta 111 meses (27); para el periodo comprendido durante el seguimiento de los pacientes que participaron en esta investigación, se registraron dos muertes menos en el grupo de profilaxis, pero no se analizó el efecto de la profilaxis en la supervivencia en esta cohorte.…”

Section: Discussionunclassified

Efectividad de la profilaxis para enfermedad tuberculosa en pacientes infectados por el virus de la inmunodeficiencia humana, Medellín, 2002-2005

Arbeláez¹,

Arbeláez²,

Posada-Gómez³

et al. 2010

biomedica

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Introducción. La profilaxis para tuberculosis ha sido aceptada mundialmente para prevenir las formas activas de la enfermedad, especialmente, en pacientes positivos para VIH; pero en los países de alta prevalencia es aún controvertida su efectividad y sus indicaciones. Objetivo. Establecer en pacientes positivos para VIH el nivel de efectividad de dos esquemas de profilaxis contra la tuberculosis: con isoniacida durante nueve meses o pirazinamida/ rifampicina durante 60 días, suministrados en forma autoadministrada, independientemente de la respuesta a la prueba de tuberculina. Materiales y métodos. Estudio observacional de cohorte. Se conformaron dos grupos, uno con 131 pacientes, quienes voluntariamente aceptaron recibir uno de los dos esquemas profilácticos, si el de pirazinamida/rifampicina no estaba contraindicado. El grupo control estuvo conformado por 200 pacientes seleccionados retrospectivamente, a partir de los registros de un programa de control de pacientes con VIH/sida. El seguimiento para ambos grupos se realizó durante dos años, mediante revisión de la historia clínica. Resultados. Los grupos no presentaron diferencias estadísticas significativas cuando se compararon sus características clínicas, ni demográficas. Una mayor proporción de pacientes del grupo control tuvieron recuento de CD4<200/ml y carga viral>100.000. En el grupo con profilaxis, 8% manifestó efectos adversos, una persona presentó tuberculosis (0,8%) y en el grupo control 10 (5%) [RR=0,15, IC95% 0,18, p=0,07], la protección de la profilaxis fue del 80%, independiente de CD4, carga viral y terapia antirretroviral recibida. Conclusión. La profilaxis para tuberculosis mostró ser efectiva en pacientes positivos para VIH, independientemente del estado inmune, virológico y el tratamiento antirretroviral recibido.Palabras clave: tuberculosis/terapia, profilaxis antibiótica, VIH, síndrome de inmunodeficiencia adquirida, terapia antirretroviral altamente activa, efectividad, Colombia.

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Isoniazid Preventive Therapy and Risk for Resistant Tuberculosis

Abstract: Preventive therapy may increase risk for drug resistance.

Cited by 205 publications

References 34 publications

Ability of preventive therapy to cure latent Mycobacterium tuberculosis infection in HIV-infected individuals in high-burden settings

Ability of preventive therapy to cure latent Mycobacterium tuberculosis infection in HIV-infected individuals in high-burden settings

Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control

Efectividad de la profilaxis para enfermedad tuberculosa en pacientes infectados por el virus de la inmunodeficiencia humana, Medellín, 2002-2005

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