Tuberculosis outcomes and drug susceptibility in individuals exposed to isoniazid preventive therapy in a high HIV prevalence setting

Halsema, Clare L van; Fielding, Katherine; Chihota, Violet; Russell, Elizabeth C.; Lewis, James J.; Churchyard, Gavin J.; Grant, Alison D.

doi:10.1097/qad.0b013e32833849df

Cited by 55 publications

(38 citation statements)

References 9 publications

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“…[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. [46] The impact of wide-scale uptake of preventive therapy on generating drug resistance is unknown. Mathematical modelling suggests that the emergence of isoniazid resistance with IPT use may be reduced by delivering IPT to those who will benefit the most and by improved case finding and prompt treatment of those with drug-resistant TB disease.…”

Section: Isoniazid Resistancementioning

confidence: 99%

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

et al. 2014

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Section: Isoniazid Resistancementioning

confidence: 99%

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

et al. 2014

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“…57,58 Inappropriate isoniazid monotherapy may even be lifesaving in HIV-positive patients with difficult-to-diagnose TB, 59 and there is no clear evidence of increasing drug resistance. 60,61 The extent to which subclinical TB contributes to overall TB transmission is unclear, 36 and will depend on how infectiousness relates to symptoms ( Figure 3). Local TB epidemiology can be dominated by stable, minimally symptomatic but highly infectious 'super-spreaders', 62 but this does not appear to be a common phenotype, 26 and pronounced reductions in undiagnosed TB at the population level can be achieved without systematic screening for subclinical TB.…”

Section: Subclinical Tuberculosismentioning

confidence: 99%

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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SUMMARYTwenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality.More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal.In the present study, we review the evidence available to guide expanded TB screening in HIVprevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. In high human immunodeficiency virus (HIV) prevalence settings, population-level tuberculosis (TB) incidence increased in parallel with adult HIV prevalence in the 1990s and remains extremely high, with over 1% of adults diagnosed with TB each year in many Southern African towns. 1 Outbreaks of multi-and extensively drug-resistant TB (XDR-TB) have been generated in HIV care clinics, and then spread into general communities. 2,3 Autopsy studies show that TB is the single biggest killer of people living with HIV (PLHIV), being the cause in 32% to 45% of HIV-related deaths 4 and with a high proportion of fatal cases undiagnosed in life. 4,5 Of the estimated 430 000 TB-related deaths among PLHIV during 2011, 79% were in Africa. These stark facts demonstrate the urgent need to strengthen TB prevention and care services using all available approaches, including more ambitious TB screening strategies.TB screening is the first step in both anti-tuberculosis treatment and TB prevention pathways, and has an integral place in routine HIV care and infection control. Key potential entry points for TB screening are illustrated in Figure 1. TB screening c...

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“…16 A despeito das recomendações em curso, a implementação da quimioprofilaxia em nível global continua em graus muito baixos, atingindo, segundo o relatório da OMS de 2007, menos de 0,1% dos pacientes HIV+. 9,12,17 A prova tuberculínica (PT), realizada pelo inóculo do derivado proteico purificado (PPD) na técnica de Mantoux é, ainda hoje, o teste de escolha para o diagnóstico dos pacientes com ILTB. 1,6,11 As recomendações do Ministério da Saúde esclarecem que os indivíduos HIV+ devem realizar a PT no momento do diagnóstico de HIV/aids e anualmente, caso sejam não reatores (enduração <5mm).…”

Section: Introductionunclassified

Indicação da prova tuberculínica e infecção latente da tuberculose em HIV-positivos, Município de Blumenau, Estado de Santa Catarina, Brasil, 2004-2009

Siqueira¹,

Mendonça²,

Penedo³

2012

Epidemiol. Serv. Saúde

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Tuberculosis outcomes and drug susceptibility in individuals exposed to isoniazid preventive therapy in a high HIV prevalence setting

Abstract: TB after recent IPT has prevalence of drug resistance similar to background and treatment outcomes typical of this setting. These data support wider implementation of IPT.

Cited by 55 publications

References 9 publications

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

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

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Indicação da prova tuberculínica e infecção latente da tuberculose em HIV-positivos, Município de Blumenau, Estado de Santa Catarina, Brasil, 2004-2009

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