Use of Isoniazid Preventive Therapy for Tuberculosis Prophylaxis Among People Living With HIV/AIDS

Briggs, Melissa A.; Emerson, Courtney; Modi, Surbhi; Taylor, Nicholas Kenji; Date, Anand

doi:10.1097/qai.0000000000000497

Cited by 49 publications

(36 citation statements)

References 45 publications

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“…22,[28][29][30][31] Evidence for the added value of IPT in patients receiving ART was mostly from patients with CD4+ counts of less than 500 cells per cubic millimeter. [32][33][34][35][36][37][38] Our data are consistent with these previous studies that showed that IPT and ART have additive efficacy with respect to the prevention of tuberculosis and that suggested that the two therapies should be given concomitantly. They also highlight for countries that are reluctant to recommend IPT that isoniazid can be prescribed safely when given early in the course of HIV disease.…”

Section: Discussionsupporting

confidence: 90%

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

2015

N Engl J Med

1,035

447

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BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

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Section: Discussionsupporting

confidence: 90%

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

2015

N Engl J Med

1,035

447

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“…Isoniazid preventive therapy (IPT) decreases risk of progression from latent TB infection (LTBI) to active TB, 6–8 and IPT provision to high-risk groups is a cornerstone of the World Health Organization (WHO) End TB Strategy. 9,10 Despite WHO recommendations, 7 there has been limited global uptake of this intervention.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Isoniazid Preventive Therapy Care Cascade Among HIV-Positive Female Sex Workers in Mombasa, Kenya

LaCourse

Deya

Graham

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Kenyan female sex workers (FSWs) have a high HIV prevalence, increasing their tuberculosis (TB) risk. Despite recommendations that HIV-positive individuals be offered isoniazid preventive therapy (IPT), uptake has been limited. Methods In this longitudinal cohort of HIV-positive FSWs, we retrospectively characterized the IPT care cascade between March 2000–January 2010, including reasons for cascade loss or appropriate exit. Cascade success required completion of 6 months of IPT. Baseline characteristics were assessed as potential correlates of cascade losses using multivariable logistic regression. Results Among 642 HIV-positive FSWs eligible for IPT evaluation, median age was 31 years (IQR 26–35) with median CD4 lymphocyte count of 409 (IQR 292–604) cells/mm3. There were 249 (39%) women who successfully completed 6 months of IPT, 157 (24%) appropriately exited the cascade, and 236 (37%) were cascade losses. Most cascade losses occurred at symptom screen (38%, 90/236), CXR evaluation (28%, 66/236), or during IPT treatment (30%, 71/236). Twenty-nine women were diagnosed with TB, including one after IPT initiation. Most women initiating IPT completed the course (71%, 249/351); <5% had medication intolerance. Younger women (<25 and 25–35 vs. >35 years; adjusted odds ratio [AOR] 2.65, 95% confidence interval [CI] 1.46–4.80 and AOR 1.78, 95% CI 1.13–2.80, respectively), and those evaluated for IPT after antiretroviral availability in 2004 (AOR 1.92, 95%CI 1.31–2.81), were more likely to be cascade losses. Conclusions Implementation of IPT among HIV-positive FSWs in Kenya is feasible. However, significant losses along the IPT care cascade underscore the need for strategies improving retention in care.

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“…TB patients testing positive for HIV should be provided with combined antiretroviral therapy (cART), which greatly improves their survival and quality of life [7]. Testing and preventatively treating HIV and AIDS patients for TB reduces TB incidence in HIV-positives [8] and may also reduce TB incidence in the general population [9]. …”

Section: Introductionmentioning

confidence: 99%

Tuberculosis and HIV coinfection in Europe

Werf

Ködmön

Zucs

et al. 2016

Aids

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Objective:To better understand the epidemiology of tuberculosis (TB)/HIV coinfection in the European Union (EU) and European Economic Area (EEA) for planning of prevention and control measures.Design:Analysis of surveillance data.Methods:We performed an analysis of the 2014 TB and AIDS data to assess the burden of TB/HIV coinfection and we applied multivariable logistic regression to evaluate predictors for coinfection.Results:Twenty-one of 31 EU/EEA countries reported HIV testing results for 64.6% of the 32 892 notified TB cases. Of those, 1051 (4.9%) were reported as HIV-positive. Males [adjusted odds ratio (aOR) 1.25; 95% confidence interval (CI) 1.07–1.46] and those in age group 25–44 years were more frequently coinfected. TB cases originating from the WHO African region had the highest proportion of coinfection (aOR 3.28 versus origin in EU/EEA; 95% CI 2.35–4.57). TB treatment was completed successfully by 57.9% of HIV-positive TB cases and 83.5% of HIV-negative cases. In 2014, 3863 cases of AIDS were reported by 29 EU/EEA countries; 691 (17.9%) of these cases presented with TB as an AIDS-defining illness. Persons who had acquired HIV through injecting drug use had higher odds of TB as an AIDS-defining illness (aOR 1.78 versus heterosexual route of transmission; 95% CI 1.37–2.32).Conclusion:TB/HIV coinfection is a substantial problem in the EU/EEA. The occurrence of TB in HIV-positive cases and the low TB treatment success rate suggest that international guidelines for prevention and treatment of TB in HIV-infected adults need to be better implemented.

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Use of Isoniazid Preventive Therapy for Tuberculosis Prophylaxis Among People Living With HIV/AIDS

Cited by 49 publications

References 45 publications

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

Evaluation of the Isoniazid Preventive Therapy Care Cascade Among HIV-Positive Female Sex Workers in Mombasa, Kenya

Tuberculosis and HIV coinfection in Europe

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