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

Abstract

Background The World Health Organization (WHO) suggests that some high-risk patient groups should receive latent tuberculosis infection (LTBI) screening and tuberculosis prevention treatment, including people living with human immunodeficiency virus (PLHIV). We performed an updated meta-analysis to compare the different LTBI therapeutic regimens for LTBI test-positive PLHIV. Methods We searched PubMed, Embase, Cochrane library, clinicaltrials.gov, and the International Clinical Trials Registry Platform for all literature and ongoing trials from their inception until November 30th, 2022. We performed a meta-analysis of the efficacy, adhesion rate, and severe adverse events; and graded the evidence quality. Results Nine studies were eligible, including two non-randomized studies (NRS) with 470 participants and seven randomized control trials (RCT)with 3,979 participants. The quality of evidence was very low for the results of the NRSs and low for the RCTs. Compared with placebo or non-treatment, both isoniazid (OR: 0.56; 95%CI 0.33-0.93) and rifamycin-based treatments (OR: 0.44; 95%CI 0.26-0.72) had efficacy for active TB prevention. Rifamycin-based regimens seem to have a better adhesion rate than isoniazid alone (RR: 1.11; 95%CI 1.04-1.19) and similar adverse events (RR: 0.73; 95%CI 0.49-1.09). Conclusions LTBI treatment decreased the active rate of TB in LTBI test-positive PLHIV. Rifamycin-based therapies may have a higher adhesion rate, while their efficacy and adverse events appear similar to isoniazid. More studies focusing on LTBI test-positive PLHIV participants would help gather high-quality evidence for decision-making.