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Yoopetch P, Anothaisintawee T, Gunasekara ADM, Jittikoon J, Udomsinprasert W, Thavorncharoensap M, Youngkong S, Thakkinstian A, Chaikledkaew U. Efficacy of anti-tuberculosis drugs for the treatment of latent tuberculosis infection: a systematic review and network meta-analysis. Sci Rep 2023; 13:16240. [PMID: 37758777 PMCID: PMC10533889 DOI: 10.1038/s41598-023-43310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
Despite the availability of three network meta-analyses (NMA) examining the efficacy, treatment completion, and adverse events associated with all latent tuberculosis infection (LTBI) treatments, there is currently no evidence to support the notion that the benefits of these treatments outweigh the potential risks. This NMA aimed to conduct a comprehensive comparison and update of the efficacy, treatment completion rates and adverse events associated with recommended treatment options for LTBI for individuals with confirmed LTBI, as outlined in the 2020 World Health Organization (WHO) Consolidated Guidelines for TB preventive treatment. A comprehensive search of the MEDLINE and Scopus databases was conducted until April 2023. The NMA was applied to estimate the risk difference and corresponding 95% confidence interval (CI) using a combination of direct and indirect evidence. The risk-benefit assessment was employed to evaluate the feasibility of the extra benefits in relation to the extra risks. The primary outcomes of interest in this study were active TB disease, completion rates, and adverse events. The meta-analysis incorporated data from 15 studies, which collectively demonstrated that the administration of a placebo resulted in a significant increase in the risk of developing TB disease by 1.279%, compared to the daily intake of isoniazid for 6 months (6H). Furthermore, treatment completion rates were significantly higher when using isoniazid plus rifapentine weekly for 3 months (3HP) and rifampicin daily for 4 months (4R), as compared to 6H. Considering adverse events, the combination of 3HP, 4R, and isoniazid administered daily for 9 months (referred to as 9H) significantly decreased adverse events by 4.53% in comparison to 6H. The risk-benefit assessment showed that alternative treatment regimens (9H, 4R, 3HR and 3HP) had a lower incidence of adverse events, while demonstrating a higher efficacy in preventing TB, as compared to 6H. This review indicates that there were no significant differences observed among various active treatment options in terms of their efficacy in preventing active TB. Moreover, completion rates were higher in 3HP and 4R, and a reduction in adverse events was observed in 3HP, 4R, and 9H.
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Affiliation(s)
- Panida Yoopetch
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Agampodi Danushi M Gunasekara
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Jiraphun Jittikoon
- Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.
- Social Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
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Efficacy, safety, and tolerability of isoniazid preventive therapy for tuberculosis in people living with HIV. AIDS 2023; 37:455-465. [PMID: 36412204 DOI: 10.1097/qad.0000000000003436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to systematically assess the efficacy, safety, and tolerability of isoniazid preventive therapy (IPT) for tuberculosis (TB) in people with HIV (PWH). DESIGN A systematic review and meta-analysis. METHODS A thorough literature search was performed using PubMed, Cochrane CENTRAL, and Google Scholar from their inception to June 30, 2021. All randomized controlled trials (RCTs) investigating the efficacy, safety, or tolerability of IPT on PWH compared with placebo or active comparators were included in the study. The heterogeneity among the studies was identified by using the I2 statistic and Cochran's Q test. RESULTS Out of the 924 nonduplicate RCTs identified through database searching and other sources, 26 studies comprising 38 005 patients were included. The overall effect estimate identified the reduction of active TB incidence [odds ratio (OR) 0.69; 95% confidence interval (95% CI) 0.57-0.84; P < 0.001], but not all-cause mortality (OR 0.91; 95% CI 0.82, 1.02; P = 0.10) with IPT compared with the control. In addition, no significant association was identified between the use of IPT and the risk of peripheral neuropathy (OR 1.50; 95% CI 0.96-2.36; P = 0.08) and hepatotoxicity (OR 1.21; 95% CI 0.97-1.52; P = 0.09). CONCLUSION This systematic review and meta-analysis identified a significant reduction in the incidence of active TB, but not all-cause mortality, among PWH who received IPT compared with the control. Lesser number of outcomes may be the reason for nonsignificant results in terms of safety outcomes of IPT. Therefore, there is a need for extensive and long-term studies to address these issues further, especially in TB/HIV endemic areas.
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Moh D, Badjé A, Kassi A, Ntakpé J, Kouame G, Ouassa T, Danel C, Domoua S, Anglaret X, Eholié S. Chimioprophylaxie antituberculeuse primaire à l'isoniazide : une stratégie d'actualité à l’ère du tester et traiter ; revue de la littérature. Rev Epidemiol Sante Publique 2022; 70:305-313. [DOI: 10.1016/j.respe.2022.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 02/28/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
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Aboma M, Dida N. Tuberculosis screening coverage and isoniazid preventive therapy among people living with HIV at Gambella Hospital, southwest Ethiopia: a retrospective study design. J Int Med Res 2021; 49:3000605211046133. [PMID: 34551613 PMCID: PMC8485319 DOI: 10.1177/03000605211046133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective We aimed to assess the coverage of tuberculosis screening and isoniazid preventive therapy (IPT) among people living with human immunodeficiency virus (PLHIV) at Gambella Hospital, southwest Ethiopia. Methods We conducted a 5-year retrospective study of PLHIV receiving care in an antiretroviral therapy clinic from 1 January 2011 to 30 December 2015. We reviewed a total of 900 medical records of patients with complete information. Result Of the total, 897 (99.7%) PLHIV were screened for tuberculosis, among which 77 (8.6%) were found to be positive for active tuberculosis. Among 820 (91.4%) individuals eligible for IPT, only 545 (66.5%) were provided IPT; 275 (33.5%) eligible PLHIV were not provided IPT. Male sex (adjusted odds ratio [AOR] 1.63) and ages 18–29 years (AOR 0.33) and 30–44 years (AOR 0.31) were significantly associated with the likelihood of tuberculosis infection. Conclusion The present study findings demonstrated that tuberculosis screening for PLHIV at Gambella Hospital was improved in comparison with reports from many African countries and other parts of Ethiopia. Despite this improvement, the implementation rate of IPT was below national and World Health Organization recommendations. Overall, tuberculosis diagnostic approaches and available preventive measures should be strengthened in the study area.
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Affiliation(s)
- Mecha Aboma
- Department of Public Health, Medicine and Health Sciences College, Ambo University, Ambo, Ethiopia
| | - Nagasa Dida
- Department of Public Health, Medicine and Health Sciences College, Ambo University, Ambo, Ethiopia
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Yanes-Lane M, Ortiz-Brizuela E, Campbell JR, Benedetti A, Churchyard G, Oxlade O, Menzies D. Tuberculosis preventive therapy for people living with HIV: A systematic review and network meta-analysis. PLoS Med 2021; 18:e1003738. [PMID: 34520459 PMCID: PMC8439495 DOI: 10.1371/journal.pmed.1003738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) preventive therapy (TPT) is an essential component of care for people living with HIV (PLHIV). We compared efficacy, safety, completion, and drug-resistant TB risk for currently recommended TPT regimens through a systematic review and network meta-analysis (NMA) of randomized trials. METHODS AND FINDINGS We searched MEDLINE, Embase, and the Cochrane Library from inception through June 9, 2020 for randomized controlled trials (RCTs) comparing 2 or more TPT regimens (or placebo/no treatment) in PLHIV. Two independent reviewers evaluated eligibility, extracted data, and assessed the risk of bias. We grouped TPT strategies as follows: placebo/no treatment, 6 to 12 months of isoniazid, 24 to 72 months of isoniazid, and rifamycin-containing regimens. A frequentist NMA (using graph theory) was carried out for the outcomes of development of TB disease, all-cause mortality, and grade 3 or worse hepatotoxicity. For other outcomes, graphical descriptions or traditional pairwise meta-analyses were carried out as appropriate. The potential role of confounding variables for TB disease and all-cause mortality was assessed through stratified analyses. A total of 6,466 unique studies were screened, and 157 full texts were assessed for eligibility. Of these, 20 studies (reporting 16 randomized trials) were included. The median sample size was 616 (interquartile range [IQR], 317 to 1,892). Eight were conducted in Africa, 3 in Europe, 3 in the Americas, and 2 included sites in multiple continents. According to the NMA, 6 to 12 months of isoniazid were no more efficacious in preventing microbiologically confirmed TB than rifamycin-containing regimens (incidence rate ratio [IRR] 1.0, 95% CI 0.8 to 1.4, p = 0.8); however, 6 to 12 months of isoniazid were associated with a higher incidence of all-cause mortality (IRR 1.6, 95% CI 1.2 to 2.0, p = 0.02) and a higher risk of grade 3 or higher hepatotoxicity (risk difference [RD] 8.9, 95% CI 2.8 to 14.9, p = 0.004). Finally, shorter regimens were associated with higher completion rates relative to longer regimens, and we did not find statistically significant differences in the risk of drug-resistant TB between regimens. Study limitations include potential confounding due to differences in posttreatment follow-up time and TB incidence in the study setting on the estimates of incidence of TB or all-cause mortality, as well as an underrepresentation of pregnant women and children. CONCLUSIONS Rifamycin-containing regimens appear safer and at least as effective as isoniazid regimens in preventing TB and death and should be considered part of routine care in PLHIV. Knowledge gaps remain as to which specific rifamycin-containing regimen provides the optimal balance of efficacy, completion, and safety.
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Affiliation(s)
- Mercedes Yanes-Lane
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
| | - Edgar Ortiz-Brizuela
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jonathon R. Campbell
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- * E-mail:
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Beshaw MA, Balcha SA, Lakew AM. Effect of Isoniazid Prophylaxis Therapy on the Prevention of Tuberculosis Incidence and Associated Factors Among HIV Infected Individuals in Northwest Ethiopia: Retrospective Cohort Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:617-629. [PMID: 34135640 PMCID: PMC8197569 DOI: 10.2147/hiv.s301355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022]
Abstract
Background Treating latent tuberculosis (TB) infection with Isoniazid (INH) among human immune virus (HIV) infected patients reduces active TB occurrence and death by 62% and 26%, respectively. Even though other studies show aforementioned evidence, TB incidence and its associated factors among HIV-infected individuals who were on INH and never on INH is not well studied in northwest Ethiopia. Therefore, this study tried to assess the effect of INH prophylaxis in TB prevention and associated factors among HIV-infected individuals. Methods Data were extracted from charts of HIV-infected clients who completed INH (193) and were never on INH (198) after a simple random sampling selection was done among newly diagnosed patients on follow-up from 2008 to 2015. After data were collected, it was entered into Epi info version 7 and exported to SPSS version 22 for analysis. Cox regression model was fitted and the hazard ratio was reported. Results In this study, the overall TB incidence rate among HIV patients was 3.5/100 person-years (PY) [95% CI: 2.55, 4.82]. But it was 7.1/100 PY among patients who were never on INH and 0.35/100 PY among patients who completed INH. INH completed [adjusted hazard ratio (AHR) = 0.08, 95% CI: 0.02–0.37], on anti-retroviral therapy (ART) [AHR = 0.02, 95% CI: 0.01–0.04], baseline World Health Organization (WHO) stage I & II [AHR =0.22, 95% CI: 0.08–0.62] and baseline CD4 ≤ 350 [AHR=3.76, 95% CI: 1.39–10.18] were significantly associated with TB incidence. Conclusion Putting patients on INH for 6 months and ART were protective factors against TB. Therefore, health institutions are recommended to provide INH after ruling out active TB and contraindications for HIV-infected individuals.
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Affiliation(s)
- Mulat Addis Beshaw
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rajpal S, Arora VK. Latent TB (LTBI) treatment: Challenges in India with an eye on 2025: "To Treat LTBI or not to treat, that is the question". Indian J Tuberc 2020; 67:S43-S47. [PMID: 33308671 DOI: 10.1016/j.ijtb.2020.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
Latent tuberculosis infection (LTBI) is defined as a consistent immune response to Mycobacterium tuberculosis antigens without evidence of clinically evident active tuberculosis (TB). Diagnosis and treatment for LTBI are important for TB, especially in high-risk populations especially in high prevalent country like India. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are used to diagnose LTBI. Therefore an unequivocal policy /of diagnosis and treatment of LTBI will serve to ameliorate the standards of the Indian health scenario and bring the TB infection to the propinquity of its ultimate elimination.
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Affiliation(s)
| | - V K Arora
- Vice Chairman Publication & Research, Honorary Treasurer, Honorary Technical Advisor, TB Association of India, India
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Abstract
Abstract
Purpose of Review
Tuberculosis is the number one infectious killer of people with HIV worldwide, but it can be both prevented and treated. Prevention of tuberculosis by screening for and treating latent tuberculosis infection (LTBI), along with the initiation of antiretroviral therapy (ART), is the key component of HIV care.
Recent Findings
While access to ART has increased worldwide, uptake and completion of LTBI treatment regimens among people living with HIV (PWH) are very poor. Concomitant TB-preventive therapy and ART are complex because of drug–drug interactions, but these can be managed. Recent clinical trials of shorter preventive regimens have demonstrated safety and efficacy in PWH with higher completion rates. More research is needed to guide TB-preventive therapy in children and in pregnant women, and for drug-resistant TB (DR-TB).
Summary
Antiretroviral therapy and tuberculosis-preventive treatment regimens can be optimized to avoid drug–drug interactions, decrease pill burden and duration, and minimize side effects in order to increase adherence and treatment completion rates among PWH and LTBI.
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Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, Menzies D, Horsburgh CR, Crane CM, Burgos M, LoBue P, Winston CA, Belknap R. Guidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. Am J Transplant 2020. [DOI: 10.1111/ajt.15841] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Gibril Njie
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CDC Atlanta Georgia USA
| | - Dominik Zenner
- Institute for Global Health University College London London England
| | - David L. Cohn
- Denver Health and Hospital Authority Denver Colorado USA
| | - Randall Reves
- Denver Health and Hospital Authority Denver Colorado USA
| | - Amina Ahmed
- Levine Children’s Hospital Charlotte North Carolina USA
| | - Dick Menzies
- Montreal Chest Institute and McGill International TB Centre Montreal Canada USA
| | - C. Robert Horsburgh
- Boston University Schools of Public Health and Medicine Boston Massachusetts USA
| | - Charles M. Crane
- National Tuberculosis Controllers Association Smyrna Georgia USA
| | - Marcos Burgos
- National Tuberculosis Controllers Association Smyrna Georgia USA
- New Mexico Department of Health University of New Mexico Health Science Center Albuquerque New Mexico USA
| | - Philip LoBue
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CDC Atlanta Georgia USA
| | - Carla A. Winston
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CDC Atlanta Georgia USA
| | - Robert Belknap
- Denver Health and Hospital Authority Denver Colorado USA
- National Tuberculosis Controllers Association Smyrna Georgia USA
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Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, Menzies D, Horsburgh CR, Crane CM, Burgos M, LoBue P, Winston CA, Belknap R. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep 2020; 69:1-11. [PMID: 32053584 PMCID: PMC7041302 DOI: 10.15585/mmwr.rr6901a1] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Comprehensive guidelines for treatment of latent tuberculosis infection (LTBI) among persons living in the United States were last published in 2000 (American Thoracic Society. CDC targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221–47). Since then, several new regimens have been evaluated in clinical trials. To update previous guidelines, the National Tuberculosis Controllers Association (NTCA) and CDC convened a committee to conduct a systematic literature review and make new recommendations for the most effective and least toxic regimens for treatment of LTBI among persons who live in the United States. The systematic literature review included clinical trials of regimens to treat LTBI. Quality of evidence (high, moderate, low, or very low) from clinical trial comparisons was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. In addition, a network meta-analysis evaluated regimens that had not been compared directly in clinical trials. The effectiveness outcome was tuberculosis disease; the toxicity outcome was hepatotoxicity. Strong GRADE recommendations required at least moderate evidence of effectiveness and that the desirable consequences outweighed the undesirable consequences in the majority of patients. Conditional GRADE recommendations were made when determination of whether desirable consequences outweighed undesirable consequences was uncertain (e.g., with low-quality evidence). These updated 2020 LTBI treatment guidelines include the NTCA- and CDC-recommended treatment regimens that comprise three preferred rifamycin-based regimens and two alternative monotherapy regimens with daily isoniazid. All recommended treatment regimens are intended for persons infected with Mycobacterium tuberculosis that is presumed to be susceptible to isoniazid or rifampin. These updated guidelines do not apply when evidence is available that the infecting M. tuberculosis strain is resistant to both isoniazid and rifampin; recommendations for treating contacts exposed to multidrug-resistant tuberculosis were published in 2019 (Nahid P, Mase SR Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med 2019;200:e93–e142). The three rifamycin-based preferred regimens are 3 months of once-weekly isoniazid plus rifapentine, 4 months of daily rifampin, or 3 months of daily isoniazid plus rifampin. Prescribing providers or pharmacists who are unfamiliar with rifampin and rifapentine might confuse the two drugs. They are not interchangeable, and caution should be taken to ensure that patients receive the correct medication for the intended regimen. Preference for these rifamycin-based regimens was made on the basis of effectiveness, safety, and high treatment completion rates. The two alternative treatment regimens are daily isoniazid for 6 or 9 months; isoniazid monotherapy is efficacious but has higher toxicity risk and lower treatment completion rates than shorter rifamycin-based regimens. In summary, short-course (3- to 4-month) rifamycin-based treatment regimens are preferred over longer-course (6–9 month) isoniazid monotherapy for treatment of LTBI. These updated guidelines can be used by clinicians, public health officials, policymakers, health care organizations, and other state and local stakeholders who might need to adapt them to fit individual clinical circumstances.
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Does Isoniazid Preventive Therapy Provide Better Treatment Outcomes in HIV-Infected Individuals in Northern Ethiopia? A Retrospective Cohort Study. AIDS Res Treat 2020; 2020:7025738. [PMID: 32411454 PMCID: PMC7204289 DOI: 10.1155/2020/7025738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/26/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives Early antiretroviral therapy (ART), isoniazid preventive therapy (IPT), and isoniazid-rifapentine (3HP) are effective strategies for preventing tuberculosis (TB) among people living with HIV (PLHIV). The study aimed to determine the effect of IPT on the TB incidence, follow-up CD4+ T cells, and all-cause mortality rate. Participants. Eligible patients on ART (n = 1, 863) were categorized into one-to-two ratios of exposed groups to IPT (n = 621) and nonexposed groups to IPT (n = 1, 242). Exposed groups entered the cohort at their first prescription of IPT, and unexposed groups entered into the study at the first prescription of ART and then followed until the occurrence of the outcome or date of administrative censoring (June 30, 2017). The outcome endpoints were TB incidence, follow-up CD4+ T cells, and all-cause mortality rate. Results The follow-up CD4+ T cells for the exposed and nonexposed groups were 405.74 and 366.95 cells/mm (World Health Organization (WHO), 2017), respectively, a statistically significant finding (t 1861 = -3.770, p < 0.0001; Cohen's d = 0.186). Nine percent of the exposed patients (620 incidence of TB per 100,000 person-years (PYs)) and 21.9% of the nonexposed patients (3160 incidence of TB per 100,000 PYs) developed TB. Mortality rate (per 100,000 PYs) was 440 for the exposed and 1490 for the unexposed patients. Statistically significant determinants of the all-cause mortality were unscheduled follow-up (AHR = 1.601; 95% CI: 1.154-2.222) and unable to work properly (AHR = 2.324; 95% CI: 1.643-3.288). Conclusion This study demonstrates the effect of IPT in reducing incidence of TB and all-cause mortality rate and improving follow-up CD4+ T cells. Promoting IPT use can help to achieve the TB eradicating national agenda in Ethiopia.
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Chaisson LH, Saraceni V, Cohn S, Seabrook D, Cavalcante SC, Chaisson RE, Golub JE, Durovni B. CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV. AIDS 2020; 34:139-147. [PMID: 31634189 PMCID: PMC7112158 DOI: 10.1097/qad.0000000000002398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES In 2018, Brazilian guidelines changed to recommend tuberculosis (TB) preventive therapy for all people with HIV and a CD4 cell count 350 cells/μl or less, but only for those with a positive tuberculin skin test (TST) if CD4 cell count is than 350 cells/μl. We determined the potential effectiveness of CD4-based guidelines for TB testing and preventive therapy. DESIGN Secondary analysis of the stepped-wedge, cluster-randomized THRio trial for isoniazid preventive therapy (IPT). METHODS We analyzed data from 4114 newly registered patients with HIV in 29 clinics followed until TB diagnosis, death, or administrative censoring. We compared incidence rates of TB and TB/death between CD4, TST, IPT, and antiretroviral therapy categories. RESULTS Initial CD4 cell count was 350 cells/μl or less in 2138 (52%) and more than 350 cells/μl in 1976 (48%) patients. TST was performed for 2922 (71%), of whom 657 (16%) were TST-positive [278 (13%) CD4 ≤ 350 vs. 379 (19%) CD4 > 350]. A total of 619 (15%) received IPT and 2806 (68%) received antiretroviral therapy. For patients with CD4 cell count 350 cells/μl or less who did not receive IPT, the incidence rate of TB was 1.79/100 person-years (pys) and TB/death was 3.89/100 pys. For patients with CD4 cell count more than 350 who did not receive IPT, the incidence rates of TB and TB/death were 0.57/100 and 1.49/100 pys for TST-negatives, and 1.05/100 and 1.64/100 pys for TST-unknowns. CONCLUSION TB incidence was high among all patients who did not receive IPT, including those with CD4 cell count more than 350 cells/μl and negative or unknown TST results. TB preventive therapy should be provided to all people living with HIV in medium burden settings, regardless of CD4 cell count and TST status.
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Affiliation(s)
- Lelia H Chaisson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Municipal Health Secretariat, Rio de Janeiro, Brazil Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland Linksbridge SPC, Seattle, Washington, USA Instituto Nacional de Infectologia Evandro Chagas Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Stout JE, Sterling TR, Horsburgh CR. One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis. N Engl J Med 2019; 381:e23. [PMID: 31509689 DOI: 10.1056/nejmc1908492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Badje A, Moh R, Gabillard D, Guéhi C, Kabran M, Ntakpé JB, Carrou JL, Kouame GM, Ouattara E, Messou E, Anzian A, Minga A, Gnokoro J, Gouesse P, Emieme A, Toni TD, Rabe C, Sidibé B, Nzunetu G, Dohoun L, Yao A, Kamagate S, Amon S, Kouame AB, Koua A, Kouamé E, Daligou M, Hawerlander D, Ackoundzé S, Koule S, Séri J, Ani A, Dembélé F, Koné F, Oyebi M, Mbakop N, Makaila O, Babatunde C, Babatunde N, Bleoué G, Tchoutedjem M, Kouadio AC, Sena G, Yededji SY, Karcher S, Rouzioux C, Kouame A, Assi R, Bakayoko A, Domoua SK, Deschamps N, Aka K, N'Dri-Yoman T, Salamon R, Journot V, Ahibo H, Ouassa T, Menan H, Inwoley A, Danel C, Eholié SP, Anglaret X. Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial. LANCET GLOBAL HEALTH 2018; 5:e1080-e1089. [PMID: 29025631 DOI: 10.1016/s2214-109x(17)30372-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. METHODS For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period. FINDINGS Between March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3-5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9-5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1-9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39-0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (pinteraction=0·77) or between IPT and time (pinteraction=0·94) on mortality. INTERPRETATION In Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART. FUNDING National Research Agency on AIDS and Viral Hepatitis (ANRS).
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Affiliation(s)
- Anani Badje
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Raoul Moh
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Delphine Gabillard
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Calixte Guéhi
- Inserm 1219, University of Bordeaux, Bordeaux, France; Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d'Ivoire
| | - Mathieu Kabran
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Jean-Baptiste Ntakpé
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Jérôme Le Carrou
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Gérard M Kouame
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Eric Ouattara
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire; Centre de Prise en Charge de Recherche et de Formation (CePReF), Yopougon, Abidjan, Côte d'Ivoire
| | - Amani Anzian
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Prise en Charge de Recherche et de Formation (CePReF), Yopougon, Abidjan, Côte d'Ivoire
| | - Albert Minga
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre Médical de Suivi des Donneurs de Sang (CMSDS), Treichville, Abidjan, Côte d'Ivoire
| | - Joachim Gnokoro
- Centre de Prise en Charge de Recherche et de Formation (CePReF), Yopougon, Abidjan, Côte d'Ivoire
| | - Patrice Gouesse
- Centre de Prise en Charge de Recherche et de Formation (CePReF), Yopougon, Abidjan, Côte d'Ivoire
| | - Arlette Emieme
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Thomas-d'Aquin Toni
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire; Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA), Treichville, Abidjan, Côte d'Ivoire
| | - Cyprien Rabe
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Baba Sidibé
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Gustave Nzunetu
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Lambert Dohoun
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre Médical de Suivi des Donneurs de Sang (CMSDS), Treichville, Abidjan, Côte d'Ivoire
| | - Abo Yao
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre Médical de Suivi des Donneurs de Sang (CMSDS), Treichville, Abidjan, Côte d'Ivoire
| | - Synali Kamagate
- Centre Médical de Suivi des Donneurs de Sang (CMSDS), Treichville, Abidjan, Côte d'Ivoire
| | - Solange Amon
- Hôpital Général d'Abobo Nord, Abobo, Abidjan, Côte d'Ivoire
| | | | - Aboli Koua
- Hôpital Général d'Abobo Nord, Abobo, Abidjan, Côte d'Ivoire
| | | | - Marcelle Daligou
- Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA), Treichville, Abidjan, Côte d'Ivoire
| | - Denise Hawerlander
- Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA), Treichville, Abidjan, Côte d'Ivoire
| | - Simplice Ackoundzé
- Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA), Treichville, Abidjan, Côte d'Ivoire
| | - Serge Koule
- Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d'Ivoire
| | - Jonas Séri
- Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d'Ivoire
| | - Alex Ani
- Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d'Ivoire
| | - Fassery Dembélé
- Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d'Ivoire
| | - Fatoumata Koné
- Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d'Ivoire
| | - Mykayila Oyebi
- Formation Sanitaire Urbaine Communautaire (FSU Com) d'Anonkoua Kouté, Abobo, Abidjan, Côte d'Ivoire
| | - Nathalie Mbakop
- Formation Sanitaire Urbaine Communautaire (FSU Com) d'Anonkoua Kouté, Abobo, Abidjan, Côte d'Ivoire
| | - Oyewole Makaila
- Formation Sanitaire Urbaine Communautaire (FSU Com) d'Anonkoua Kouté, Abobo, Abidjan, Côte d'Ivoire
| | | | | | | | | | | | - Ghislaine Sena
- Centre La Pierre Angulaire, Treichville, Abidjan, Côte d'Ivoire
| | | | - Sophie Karcher
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | | | - Abo Kouame
- Programme National de Lutte contre le SIDA, Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Rodrigue Assi
- Service de Pneumologie, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Alima Bakayoko
- Service de Pneumologie, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Serge K Domoua
- Service de Pneumologie, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Nina Deschamps
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Kakou Aka
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Thérèse N'Dri-Yoman
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Service de Gastro-entéro-hépatologie, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Roger Salamon
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | | | - Hughes Ahibo
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Timothée Ouassa
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Hervé Menan
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - André Inwoley
- Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Christine Danel
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire
| | - Serge P Eholié
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
| | - Xavier Anglaret
- Inserm 1219, University of Bordeaux, Bordeaux, France; Programme PAC-CI, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) Research Center, Abidjan, Côte d'Ivoire.
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Ramadan SM, Laz NI, Eissa SAL, Elbatanouny MM, Mohammed MF. Diagnostic dilemma in tuberculous pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Edessa D, Likisa J. A Description of Mortality Associated with IPT plus ART Compared to ART Alone among HIV-Infected Individuals in Addis Ababa, Ethiopia: A Cohort Study. PLoS One 2015; 10:e0137492. [PMID: 26348618 PMCID: PMC4562624 DOI: 10.1371/journal.pone.0137492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/19/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the most common human immunodeficiency virus (HIV) associated opportunistic infection. It is the leading cause of death in HIV-infected individuals in sub-Saharan Africa. Anti-retroviral therapy (ART) and isoniazid preventive therapy (IPT) are the two useful TB preventative strategies available to reduce TB among people living with HIV (PLHIV). Therefore, the aim of this study is to compare mortality associated with IPT taken together with ART, as well as ART alone, among PLHIV. METHODS A retrospective cohort study was undertaken at Tikur Anbessa Specialized Hospital (TASH) and Zewditu Memorial Hospital (ZMH) on 185 patients receiving IPT (6 months) plus ART and 557 patients receiving ART alone. Mortality rates (MR) per 100 person-years (PYs) were used to compare mortality rates amongst the groups. Time-to-death and survival probabilities of the patients were determined using the Kaplan Meier Method. The Cox Proportional Hazard Model was employed to estimate the effect of IPT plus ART on survival of PLHIV. RESULTS The mortality cases noted in patients treated by IPT plus ART versus ART alone were 18 (4.5 cases/100 PYs) and 116 (10 cases/100 PYs), respectively. In reference to the ART alone, the IPT plus ART reduced the likelihood of death significantly (aHR 0.48; 95% CI 0.38-0.69) and median time to death was about 26 months (IQR 19-34). Moreover, WHO stage IV (aHR 2.42: 95% CI 1.42-4.11), CD4 values ≥350 cells/mm3 (aHR 0.52; 95% CI 0.28-0.94), adherence to ART (aHR 0.12; 95% CI 0.08-0.20), primary levels of education (aHR 2.20; 95% CI 1.07-4.52); and alcohol consumption (aHR 1.71; 95% CI 1.04-2.81) were factors strongly associated with mortality. CONCLUSION We found that PLHIV treated by the IPT plus ART had a lower likelihood of mortality and delayed time-to-death when compared to patients treated by ART alone.
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Affiliation(s)
- Dumessa Edessa
- Haramaya University, College of Health and Medical Sciences, Department of Pharmacology and Clinical Pharmacy, Harar, Ethiopia
| | - Jimma Likisa
- Ambo University, College of Medicine and Health Sciences, Department of Pharmacy, Clinical Pharmacy Unit, Ambo, Ethiopia
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Tedla Z, Nguyen ML, Sibanda T, Nyirenda S, Agizew TB, Girde S, Rose CE, Samandari T. Isoniazid-associated hepatitis in adults infected with HIV receiving 36 months of isoniazid prophylaxis in Botswana. Chest 2015; 147:1376-1384. [PMID: 25340318 DOI: 10.1378/chest.14-0215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The World Health Organization recommends 36 months of isoniazid preventive therapy (36IPT) for adults infected with HIV living in TB-endemic countries. We determined the rates and risk factors for isoniazid-associated hepatitis with the use of 36IPT. METHODS One thousand six adults infected with HIV received 36IPT during a pragmatic randomized trial set in Botswana public health clinics providing HIV care. Enrollment exclusion criteria included jaundice or elevations of serum transaminases (ESTs) > 2.5-fold the upper limit of normal (ULN). Participants with any CD4+ lymphocyte count were eligible and received antiretroviral therapy (ART) when CD4+ < 200 cells/μL. 36IPT was stopped for severe hepatitis (more than fivefold ULN EST) but not for moderate hepatitis (2.5-fold to fivefold ULN EST). RESULTS Pharmacy refill records showed 2,237 person-years of isoniazid receipt; 48% of participants initiated ART by 36 months. A total of 1.9% (19 of 1,006) of participants were diagnosed with severe hepatitis; three had jaundice and two of these developed hepatic encephalopathy. Another 3.1% (31 of 1,006) of participants experienced moderate hepatitis. Thirty-eight percent (19 of 50) of participants with moderate to severe hepatitis concomitantly received ART. Forty percent (20 of 50) of moderate to severe cases occurred within the first 2 months of IPT and during this period were not associated with receipt of ART at baseline (hazard ratio, 1.49; 95% CI, 0.20-11.1; P = .70). CONCLUSIONS Adults infected with HIV receiving 36IPT did not have an increased incidence of moderate to severe hepatitis or hepatic encephalopathy compared with published reports among people infected with HIV, people not infected with HIV in trials or public health programs. Compared with participants not receiving ART, the risk of moderate to severe hepatitis was not increased by ART. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00164281; URL: www.clinicaltrials.gov.
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Affiliation(s)
| | - Minh-Ly Nguyen
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination
| | | | | | | | - Sonali Girde
- Division of HIV/AIDS Prevention, Atlanta, GA; ICF International, Inc, Atlanta, GA
| | | | - Taraz Samandari
- CDC Botswana, Gaborone, Botswana; Centers for Disease Control and Prevention, Division of Tuberculosis Elimination.
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Golub JE, Cohn S, Saraceni V, Cavalcante SC, Pacheco AG, Moulton LH, Durovni B, Chaisson RE. Long-term protection from isoniazid preventive therapy for tuberculosis in HIV-infected patients in a medium-burden tuberculosis setting: the TB/HIV in Rio (THRio) study. Clin Infect Dis 2014; 60:639-45. [PMID: 25365974 DOI: 10.1093/cid/ciu849] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The duration of protection against tuberculosis provided by isoniazid preventive therapy is not known for human immunodeficiency virus (HIV)-infected individuals living in settings of medium tuberculosis incidence. METHODS We conducted an individual-level analysis of participants in a cluster-randomized, phased-implementation trial of isoniazid preventive therapy. HIV-infected patients who had positive tuberculin skin tests (TSTs) were followed until tuberculosis diagnosis, death, or administrative censoring. Nelson-Aalen cumulative hazard plots were generated and hazards were compared using the log-rank test. Cox proportional hazards models were fitted to investigate factors associated with tuberculosis diagnosis. RESULTS Between 2003 and 2009, 1954 patients with a positive TST were studied. Among these, 1601 (82%) initiated isoniazid. Overall tuberculosis incidence was 1.39 per 100 person-years (PY); 0.53 per 100 PY in those who initiated isoniazid and 6.52 per 100 PY for those who did not (adjusted hazard ratio [aHR], 0.17; 95% confidence interval [CI], .11-.25). Receiving antiretroviral therapy at time of a positive TST was associated with a reduced risk of tuberculosis (aHR, 0.69; 95% CI, .48-1.00). Nelson-Aalen plots of tuberculosis incidence showed a constant risk, with no acceleration in 7 years of follow-up for those initiating isoniazid preventive therapy. CONCLUSIONS Isoniazid preventive therapy significantly reduced tuberculosis risk among HIV-infected patients with a positive TST. In a medium-prevalence setting, 6 months of isoniazid in HIV-infected patients with positive TST reduces tuberculosis risk over 7 years of follow-up, in contrast to results of studies in higher-burden settings in Africa.
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Affiliation(s)
- Jonathan E Golub
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silvia Cohn
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Solange C Cavalcante
- Municipal Health Secretariat Instituto de Pesquisa Clinica Evandro Chagas-FIOCRUZ
| | | | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Betina Durovni
- Municipal Health Secretariat Federal University of Rio de Janeiro, Brazil
| | - Richard E Chaisson
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Latent Tuberculosis screening using interferon-gamma release assays in an Australian HIV-infected cohort: is routine testing worthwhile? J Acquir Immune Defic Syndr 2014; 66:48-54. [PMID: 24457631 DOI: 10.1097/qai.0000000000000109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data from high-income countries on the performance of interferon-gamma release assays in screening for latent tuberculosis infection (LTBI). We analyzed the routine application of the Quantiferon-TB Gold (QFT-G) assay to detect and predict latent and active TB among HIV-infected patients in Australia. METHODS A retrospective cohort study included all HIV-infected patients attending the Melbourne Sexual Health Service between March 2003 and February 2011 who were screened for LTBI using QFT-G. Clinical data were analyzed in multivariable models to determine predictors for QFT-G positivity using logistic regression and active TB development using Cox proportional hazards. RESULTS Nine hundred seventeen HIV-infected patients had ≥1 QFT-G performed, of whom 884 (96.4%) were negative, 29 (3.2%) positive, and 4 (0.4%) indeterminate. The mean age was 40.9 years and 88% were male, with median follow-up of 26.4 (interquartile range 15.4-30.7) months. Five hundred fifty (63%) were Australian born, whereas 198 (23%) were born in Asia or Africa. QFT-G was positive in 2.0% of Australian-born, 5.3% of overseas-born [odds ratio: 2.6, 95% confidence interval (CI): 1.2 to 5.6, P = 0.017], and 12.7% of African-born patients (odds ratio 7.1, 95% CI: 2.9 to 17.3, P < 0.001). Two cases of culture-positive TB occurred after QFT-G screening in 3.4% of QFT-G-positive and 0.1% of QFT-G-negative patients (adjusted hazard ratio: 42.4, 95% CI: 2.2 to 827, P = 0.013), a rate of 111 (95% CI: 27.8 to 445) per 100,000 person-years. CONCLUSIONS In this context, QFT-G has a high negative predictive (99.9%) value with few indeterminate results. A risk stratification approach to LTBI screening, where HIV-infected patients with epidemiological risk factors for TB infection undergo QFT-G testing, might be clinically appropriate and potentially cost effective in similar settings.
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Willemot P, Klein MB. Prevention of HIV-associated opportunistic infections and diseases in the age of highly active antiretroviral therapy. Expert Rev Anti Infect Ther 2014; 2:521-32. [PMID: 15482218 DOI: 10.1586/14787210.2.4.521] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the introduction of highly active antiretroviral therapy (HAART), the rates of opportunistic infections have decreased markedly as has overall morbidity and mortality from HIV infection in developed countries. However, opportunistic infections remain the most important cause of death in HIV-infected people due to both late presentation of HIV infections and failure of HAART to adequately restore cell-mediated immunity in all individuals. While prophylaxis may be discontinued in patients who have responded to HAART with sustained increases of their CD4 counts above risk thresholds, for those patients who fail HAART, those who are unable to tolerate it, or whose treatments are interrupted, opportunistic-infection prophylaxis remains essential. Some HIV-associated diseases, such as anogenital human papilloma virus-induced neoplasia and hepatitis C infection, have not decreased in frequency with the advent of HAART. For these conditions, effective screening and treatment programs will be necessary to prevent ongoing morbidity. This review will provide an update on HIV-associated opportunistic infections and their prevention in the age of HAART, as well as discuss novel presentations of opportunistic illnesses, such as immune restoration syndromes.
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Affiliation(s)
- Patrick Willemot
- Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec H2X 2P4, Canada.
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Swaminathan S, Menon PA, Gopalan N, Perumal V, Santhanakrishnan RK, Ramachandran R, Chinnaiyan P, Iliayas S, Chandrasekaran P, Navaneethapandian PD, Elangovan T, Pho MT, Wares F, Paranji Ramaiyengar N. Efficacy of a six-month versus a 36-month regimen for prevention of tuberculosis in HIV-infected persons in India: a randomized clinical trial. PLoS One 2012; 7:e47400. [PMID: 23251327 PMCID: PMC3522661 DOI: 10.1371/journal.pone.0047400] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 09/14/2012] [Indexed: 01/20/2023] Open
Abstract
Background The optimal duration of preventive therapy for tuberculosis (TB) among HIV-infected persons in TB-endemic countries is unknown. Methods An open-label randomized clinical trial was performed and analyzed for equivalence. Seven hundred and twelve HIV-infected, ART-naïve patients without active TB were randomized to receive either ethambutol 800 mg and isoniazid 300 mg daily for six-months (6EH) or isoniazid 300 mg daily for 36-months (36H). Drugs were dispensed fortnightly and adherence checked by home visits. Patients had chest radiograph, sputum smear and culture performed every six months, in addition to investigations if they developed symptoms. The primary endpoint was incident TB while secondary endpoints were all-cause mortality and adverse events. Survival analysis was performed on the modified intent to treat population (m-ITT) and rates compared. Findings Tuberculosis developed in 22 (6.4%) of 344 subjects in the 6EH arm and 13 (3.8%) of 339 subjects in the 36H arm with incidence rates of 2.4/100py (95%CI- 1.4–3.5) and 1.6/100py (95% CI-0.8–3.0) with an adjusted rate ratio (aIRR) of 1.6 (0.8–3.2). Among TST-positive subjects, the aIRR of 6EH was 1.7 (0.6–4.3) compared to 36H, p = 0.8. All-cause mortality and toxicity were similar in the two arms. Among 15 patients with confirmed TB, 4 isolates were resistant to isoniazid and 2 were multidrug-resistant. Interpretation Both regimens were similarly effective in preventing TB, when compared to historical incidence rates. However, there was a trend to lower TB incidence with 36H. There was no increase in isoniazid resistance compared to the expected rate in HIV-infected patients. The trial is registered at ClinicalTrials.gov, NCT00351702.
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Affiliation(s)
- Soumya Swaminathan
- National Institute for Research in Tuberculosis Formerly Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India.
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Abstract
Nine months of daily isoniazid is efficacious in treating latent M. tuberculosis infection, but completion rates are low, limiting treatment effectiveness. In 2011, three important studies were published involving novel regimens for the treatment of latent M. tuberculosis infection. At least 36 months of isoniazid was more effective than 6 months of isoniazid in one study, but not in another-both of which were conducted among tuberculin skin test positive HIV-infected adults living in high tuberculosis incidence settings. Three months of once-weekly isoniazid plus rifapentine or twice-weekly isoniazid plus rifampin (both given under direct observation) resulted in tuberculosis rates similar to those seen with 6 months of isoniazid among HIV-infected persons in high tuberculosis incidence settings. Three months of once-weekly, directly-observed isoniazid plus rifapentine was at least as effective as 9 months of daily isoniazid among predominantly HIV-uninfected persons living in low and medium tuberculosis incidence countries. The 3-month once-weekly isoniazid plus rifapentine regimen demonstrates promise for treatment of latent M. tuberculosis infection in HIV-infected persons.
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Fraisse P. Traitement des infections tuberculeuses latentes. Rev Mal Respir 2012; 29:579-600. [DOI: 10.1016/j.rmr.2011.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 07/26/2011] [Indexed: 11/24/2022]
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Khongphatthanayothin M, Avihingsanon A, Teeratakulpisarn N, Phanuphak N, Buajoom R, Suwanmala P, Phanuphak P. Feasibility and efficacy of isoniazid prophylaxis for latent tuberculosis in HIV-infected clients patients in Thailand. AIDS Res Hum Retroviruses 2012; 28:270-5. [PMID: 21899431 DOI: 10.1089/aid.2011.0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A prospective study was conducted in 4339 HIV-positive clients at the Thai Red Cross AIDS Research Centre (TRC-ARC) Anonymous clinic, Bangkok, Thailand between January 2003 and April 2008. A tuberculin skin test (TST) was done for all patients without a previous history of tuberculosis (TB). Nine months of isoniazid (INH) was given for all positive TST/no active TB. TST-negative clients were asked to repeat the TST annually. The study aim was to evaluate the feasibility and efficacy of INH prophylaxis for preventing TB in HIV-positive Thai patients. Of those patients, 4111 (94.7%) had a TST done; 1157 (28.1%) were TST positive and 799 patients started INH prophylaxis. In all, 551 (69%) and 633 (79.2%) patients completed 9 months and 6 months of INH, respectively; 176 (20.2%) patients had a negative TST at baseline and subsequently converted to positive. Only patients with a baseline CD4 >200 cells/μL (p=0.000) and currently on antiretroviral (ARV) treatment (p=0.000) were related to having a positive TST. This baseline CD4 level was also significantly related to higher INH completion rates at 6 months (p=0.000). Interestingly, none of INH completion patients developed active TB. The feasibility of INH prophylaxis in TST-positive patients in this setting is possible. However, the long-term advantage of INH prophylaxis in terms of TB prevention, especially in HIV-1-infected patients on highly active antiretroviral therapy (HAART), is still an issue that needs more research.
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Affiliation(s)
| | - Anchalee Avihingsanon
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Nittaya Phanuphak
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- South East Asia Research Collaboration with Hawaii (SEARCH), Bangkok, Thailand
| | | | | | - Praphan Phanuphak
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
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Intensive case finding and isoniazid preventative therapy in HIV infected individuals in Africa: economic model and value of information analysis. PLoS One 2012; 7:e30457. [PMID: 22291958 PMCID: PMC3264596 DOI: 10.1371/journal.pone.0030457] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 12/20/2011] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) accounts of much of the morbidity and mortality associated with HIV. We evaluate the cost-effectiveness of different strategies to actively screen for TB disease in HIV positive individuals, where isoniazid preventative therapy (IPT) is given to those screening negative, and use value of information analysis (VOI) to identify future research priorities. METHODOLOGY/ PRINCIPAL FINDINGS We built an individual sampling model to investigate the costs (2010 US Dollars) and consequences of screening for TB, and providing TB treatment or IPT in adults testing HIV positive in Sub-Saharan Africa. A systematic review and meta-analysis was conducted to assess performance of the nine different TB screening strategies evaluated. Probabilistic sensitivity analysis was conducted to incorporate decision uncertainty, and expected value of perfect information for the entire model and for groups of parameters was calculated. Screening all HIV infected individuals with sputum microscopy was the least costly strategy, with other strategies not cost-effective at WHO recommended thresholds. Screening those with TB symptoms with sputum microscopy and CXR would be cost-effective at a threshold ICER of $7,800 per quality-adjusted life year (QALY), but associated with significant uncertainty. VOI analysis suggests further information would be of value. CONCLUSIONS/ SIGNIFICANCE Resource-constrained countries in sub-Saharan Africa wishing to scale up TB preventative services in their HIV infected populations should consider expanding laboratory facilities to enable increased screening for TB with sputum microscopy, whilst improved estimates of the TB prevalence in the population to be screened are needed, as it may influence the optimal strategy.
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Pozniak AL, Coyne KM, Miller RF, Lipman MCI, Freedman AR, Ormerod LP, Johnson MA, Collins S, Lucas SB. British HIV Association guidelines for the treatment of TB/HIV coinfection 2011. HIV Med 2011; 12:517-24. [PMID: 21951595 DOI: 10.1111/j.1468-1293.2011.00954.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A L Pozniak
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD, UK.
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Samandari T, Agizew TB, Nyirenda S, Tedla Z, Sibanda T, Shang N, Mosimaneotsile B, Motsamai OI, Bozeman L, Davis MK, Talbot EA, Moeti TL, Moffat HJ, Kilmarx PH, Castro KG, Wells CD. 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, double-blind, placebo-controlled trial. Lancet 2011; 377:1588-98. [PMID: 21492926 DOI: 10.1016/s0140-6736(11)60204-3] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND In accordance with WHO guidelines, people with HIV infection in Botswana receive daily isoniazid preventive therapy against tuberculosis without obtaining a tuberculin skin test, but duration of prophylaxis is restricted to 6 months. We aimed to assess effectiveness of extended isoniazid therapy. METHODS In our randomised, double-blind, placebo-controlled trial we enrolled adults infected with HIV aged 18 years or older at government HIV-care clinics in Botswana. Exclusion criteria included current illness such as cough and an abnormal chest radiograph without antecedent tuberculosis or pneumonia. Eligible individuals were randomly allocated (1:1) to receive 6 months' open-label isoniazid followed by 30 months' masked placebo (control group) or 6 months' open-label isoniazid followed by 30 months' masked isoniazid (continued isoniazid group) on the basis of a computer-generated randomisation list with permuted blocks of ten at each clinic. Antiretroviral therapy was provided if participants had CD4-positive lymphocyte counts of fewer than 200 cells per μL. We used Cox regression analysis and the log-rank test to compare incident tuberculosis in the groups. Cox regression models were used to estimate the effect of antiretroviral therapy. The trial is registered at ClinicalTrials.gov, number NCT00164281. FINDINGS Between Nov 26, 2004, and July 3, 2009, we recorded 34 (3·4%) cases of incident tuberculosis in 989 participants allocated to the control group and 20 (2·0%) in 1006 allocated to the continued isoniazid group (incidence 1·26% per year vs 0·72%; hazard ratio 0·57, 95% CI 0·33-0·99, p=0·047). Tuberculosis incidence in those individuals receiving placebo escalated approximately 200 days after completion of open-label isoniazid. Participants who were tuberculin skin test positive (ie, ≥5 mm induration) at enrolment received a substantial benefit from continued isoniazid treatment (0·26, 0·09-0·80, p=0·02), whereas participants who were tuberculin skin test-negative received no significant benefit (0·75, 0·38-1·46, p=0·40). By study completion, 946 (47%) of 1995 participants had initiated antiretroviral therapy. Tuberculosis incidence was reduced by 50% in those receiving 360 days of antiretroviral therapy compared with participants receiving no antiretroviral therapy (adjusted hazard ratio 0·50, 95% CI 0·26-0·97). Severe adverse events and death were much the same in the control and continued isoniazid groups. INTERPRETATION In a tuberculosis-endemic setting, 36 months' isoniazid prophylaxis was more effective for prevention of tuberculosis than was 6-month prophylaxis in individuals with HIV infection, and chiefly benefited those who were tuberculin skin test positive. FUNDING US Centers for Disease Control and Prevention and US Agency for International Development.
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Affiliation(s)
- Taraz Samandari
- Botswana-USA Partnership (BOTUSA), Gaborone and Francistown, Botswana.
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Santin M, Casas S, Saumoy M, Andreu A, Moure R, Alcaide F, Ferrer E, Podzamczer D. Detection of latent tuberculosis by the tuberculin skin test and a whole-blood interferon-γ release assay, and the development of active tuberculosis in HIV-seropositive persons. Diagn Microbiol Infect Dis 2011; 69:59-65. [PMID: 21146715 DOI: 10.1016/j.diagmicrobio.2010.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/30/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022]
Abstract
This study evaluated the QuantiFERON-TB Gold In-Tube (QFT-GIT; Cellestis, Carnegie, Australia) test and the tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI) in HIV-infected adults. One hundred thirty-five HIV-seropositive persons and 135 controls underwent TST and QFT-GIT. HIV-infected patients who gave a positive result on either test were offered chemoprophylaxis. The prevalence of LTBI was 6.7% by TST and 9.6% by QFT-GIT (P = 0.3) in HIV-seropositive subjects, and 34.8% by TST and 21.5% by QFT-GIT (P = 0.02) among controls. TST reactivity declined sharply as CD4(+) cells fell (15.8%, 10.3%, and 0% for >500, 301-500 and ≤300 CD4(+) cells/mm(3), respectively; P = 0.002). A less pronounced fall occurred with QFT-GIT (15.8%, 13.8%, and 0% for >500, 301-500, and <100 CD4(+) cells/mm(3), respectively; P = 0.03). No cases of tuberculosis occurred during follow-up (0.26 per 100 person-years). Simultaneous testing with TST and QFT-GIT for targeting of chemoprophylaxis, early in the course of HIV infection, might minimize the risk of tuberculosis in these patients.
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Affiliation(s)
- Miguel Santin
- Department of Infectious Diseases, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) 08907 Hospitalet de Llobregat, Barcelona, Spain.
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Abstract
OBJECTIVES We describe isoniazid-related adverse events in Thibela TB, a cluster-randomized study of community-wide isoniazid preventive therapy (IPT) among gold miners in South Africa, where HIV prevalence is estimated at 30%. METHODS Consenting employees were screened prior to IPT for active tuberculosis and increased risk of isoniazid toxicity using a questionnaire and chest radiograph. Study-defined IPT-related adverse events were sought at each study visit: liver function tests were only performed if clinically indicated. In a substudy, we questioned consecutive participants at baseline and months 1, 3, and 6 concerning minor IPT-related adverse events. RESULTS Among 24,221 participants (95.2% men, median age 40 years), 130 individuals had 132 study-defined adverse events (0.54%); 61 (0.25%) possible hypersensitivity rash, 50 (0.21%) peripheral neuropathy, 17 (0.07%) clinical hepatotoxicity, and four (0.02%) convulsions. Four events (two hepatotoxicity, one fatal, and two convulsions) fulfilled criteria for seriousness. Clinical hepatotoxicity was associated with consumption of alcohol [0.11 vs. 0.03% if no alcohol consumed, odds ratio 3.9 (95% confidence interval 1.2-12.1)], but not with sex, age, weight, or concurrent antiretroviral therapy. In the substudy, 324 of 498 (65.1%) participants reported better health since starting IPT; 180 of 324 (55.6%) reported that this was because of increased appetite. The frequency of specific minor symptoms was low among those taking IPT, and all symptoms were reported less often than at baseline. CONCLUSION The risk of adverse events, particularly hepatotoxicity, was very low in this population. Our data suggest that clinical criteria can safely be used for screening prior to and monitoring during IPT.
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Implementation of isoniazid preventive therapy for people living with HIV worldwide: barriers and solutions. AIDS 2010; 24 Suppl 5:S57-65. [PMID: 21079430 DOI: 10.1097/01.aids.0000391023.03037.1f] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Why have trials of isoniazid preventive therapy among people with HIV infection not demonstrated an effect on mortality?: did close examination of the trees obscure our view of the wood? AIDS 2010; 24 Suppl 5:S15-8. [PMID: 21079423 DOI: 10.1097/01.aids.0000391011.40892.ff] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Durovni B, Cavalcante SC, Saraceni V, Vellozo V, Israel G, King BS, Cohn S, Efron A, Pacheco AG, Moulton LH, Chaisson RE, Golub JE. The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study. AIDS 2010; 24 Suppl 5:S49-56. [PMID: 21079428 PMCID: PMC3066070 DOI: 10.1097/01.aids.0000391022.95412.a6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The TB/HIV in Rio (THRio) study was launched in September 2005 to assess the impact of integrated tuberculosis (TB) and HIV treatment strategies in 29 HIV clinics in Rio de Janeiro, Brazil. DESIGN THRio is a cluster-randomized trial (CRT) to determine whether routine screening for and treatment of latent TB in HIV clinic patients with access to antiretroviral therapy will reduce TB incidence at the clinic level. THRio is part of the Consortium to Respond Effectively to AIDS/TB Epidemic that is implementing research studies to assess the impact of bold, new public health paradigms for controlling the AIDS/TB epidemic. METHODS Twenty-nine public primary HIV clinics were randomly assigned a date to begin implementing TB screening procedures and provision of isoniazid preventive therapy (IPT) for TB/HIV coinfected patients. Final analysis of the CRT is expected in 2011. RESULTS Starting at date of tuberculin skin test (TST)/IPT implementation at each clinic through August 2010, 1670 HIV-infected patients initiated IPT, of which 215 are still receiving treatment. Of the remaining 1455 patients, 1230 (85%) completed therapy and only 20 (1.2%) patients initiating IPT reported adverse reactions leading to discontinuation of therapy. IPT completion was higher among HIV-infected patients receiving HAART (87%) than those not yet receiving HAART (79%, P < 0.01). Times to TST and IPT have markedly decreased postintervention, but remain considerably long. The richness of the THRio database has resulted in several analyses of this expansive cohort of HIV-infected patients that are reviewed here. CONCLUSIONS The national implementation of TST and IPT for HIV-positive patients in Brazil has been invigorated partly due to THRio's baseline results. Expanded use of IPT in HIV patients in Rio de Janeiro is achievable with high adherence and low adverse events, although this effort requires a package of activities including training, advocacy and reorganization of services.
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Affiliation(s)
- Betina Durovni
- Municipal Health Secretariat, Brazil
- Federal University of Rio de Janeiro, Brazil
| | | | | | | | | | - Bonnie S. King
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Silvia Cohn
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne Efron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard E. Chaisson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan E. Golub
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Antiretrovirals and isoniazid preventive therapy in the prevention of HIV-associated tuberculosis in settings with limited health-care resources. THE LANCET. INFECTIOUS DISEASES 2010; 10:489-98. [DOI: 10.1016/s1473-3099(10)70078-5] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Isoniazid tuberculosis preventive therapy in HIV-infected adults accessing antiretroviral therapy: a Botswana Experience, 2004-2006. J Acquir Immune Defic Syndr 2010; 54:71-7. [PMID: 19934764 DOI: 10.1097/qai.0b013e3181c3cbf0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe reasons for exclusion from isoniazid tuberculosis preventive therapy (IPT) and outcomes of persons living with HIV (PLWH) during 6 months of IPT. METHODS In a clinical trial conducted in government clinics, first screening (screen 1) used National IPT Program guidelines and a second screening (screen 2) was trial specific. Adherence was defined as attending 6 monthly visits. RESULTS Between 2004 and 2006, at 4018 screening visits, 2934 (73%) PLWH met screen 1 criteria; 1995 (68%) met screen 2 criteria and were enrolled. Major reasons for exclusion were illness (66%) at screen 1 and abnormal chest radiographs (36%) at screen 2. Tuberculin skin tests were > or = 5 mm in 24% of those enrolled and 31% had CD4 lymphocyte counts <200 cells/mm(3). During the 6 months, 8 (0.40%) developed tuberculosis disease, 28 (1.4%) had severe adverse events (19/28 were hepatitis including one death probably isoniazid-associated), 20 others died, and 22% initiated antiretroviral therapy (ART). Although adherence was 86%, being on ART improved adherence: relative risk 1.41 (95% confidence limits 1.04-1.91). In multivariate analysis, ART was associated with a 4.38 greater odds of adherence to IPT. CONCLUSIONS Six months of IPT was relatively safe and well-tolerated by PLWH. Adherence to IPT was significantly better among those receiving ART with IPT.
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Tedla Z, Nyirenda S, Peeler C, Agizew T, Sibanda T, Motsamai O, Vernon A, Wells CD, Samandari T. Isoniazid-associated hepatitis and antiretroviral drugs during tuberculosis prophylaxis in hiv-infected adults in Botswana. Am J Respir Crit Care Med 2010; 182:278-85. [PMID: 20378730 DOI: 10.1164/rccm.200911-1783oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Little is known about the incidence of isoniazid-associated hepatitis in HIV-infected Africans who receive both isoniazid preventive therapy (IPT) and antiretroviral therapy (ART). OBJECTIVES To assess the rate of and risk factors for isoniazid (INH)-associated hepatitis in persons living with HIV (PLWH) during IPT. METHODS PLWH recruited for a clinical trial received 6 months of open-label, daily, self-administered INH at public health clinics. At screening PLWH were excluded if they had any cough, weight loss, night sweats, or other illness. Alcohol abuse was defined as meeting any CAGE criterion. INH-associated hepatitis (INH-hepatitis) was defined as having either alanine or aspartate aminotransferase greater than 5.0 times the upper limit of normal regardless of symptoms when INH was not excluded as the cause. MEASUREMENTS AND MAIN RESULTS Of 1,995 PLWH enrolled between 2004 and 2006, 1,762 adhered to at least 4 months of IPT and were analyzed. Nineteen (1.1%) developed hepatitis probably or possibly associated with INH including one death at month 6; 14 of 19 (74%) occurred in months 1-3. Antiretroviral therapy (ART) was received by 480 participants but was not statistically associated with INH-hepatitis (relative risk [RR], 1.56; 95% confidence intervals [CI], 0.62-3.9); those receiving nevirapine had a higher rate (2.0%) than those receiving efavirenz (0.9%; P = 0.34). Although alcohol use did not reach significance (RR, 1.42; 95% CI, 0.57-3.51), meeting at least one CAGE criterion approached statistical significance (RR, 2.37; 95% CI, 0.96-5.84). Neither age greater than 35 years nor the presence of hepatitis B virus core antibody was associated with INH-hepatitis. CONCLUSIONS The observed rates of INH-hepatitis were similar to published data. Six months of IPT, which is recommended by the World Health Organization, was relatively safe in this, the largest cohort of African PLWH. Clinical trial registered with www.clinicaltrials.gov (NCT 00164281).
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Affiliation(s)
- Zegabriel Tedla
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, 1600 Clifton Road NE, Mailstop E-10, Atlanta, GA 30333, USA
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Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev 2010; 2010:CD000171. [PMID: 20091503 PMCID: PMC7043303 DOI: 10.1002/14651858.cd000171.pub3] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individuals with human immunodeficiency virus (HIV) infection are at an increased risk of developing active tuberculosis (TB). It is known that treatment of latent TB infection (LTBI), also referred to as TB preventive therapy or chemoprophylaxis, helps to prevent progression to active disease in HIV negative populations. However, the extent and magnitude of protection (if any) associated with preventive therapy in those infected with HIV should be quantified. This present study is an update of the original review. OBJECTIVES To determine the effectiveness of TB preventive therapy in reducing the risk of active tuberculosis and death in HIV-infected persons. SEARCH STRATEGY This review was updated using the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, AIDSLINE, AIDSTRIALS, AIDSearch, NLM Gateway and AIDSDRUGS (publication date from 01 July 2002 to 04 April 2008). We also scanned reference lists of articles and contacted authors and other researchers in the field in an attempt to identify additional studies that may be eligible for inclusion in this review. SELECTION CRITERIA We included randomized controlled trials in which HIV positive individuals were randomly allocated to TB preventive therapy or placebo, or to alternative TB preventive therapy regimens. Participants could be tuberculin skin test positive or negative, but without active tuberculosis. DATA COLLECTION AND ANALYSIS Three reviewers independently applied the study selection criteria, assessed study quality and extracted data. Effects were assessed using relative risk for dichotomous data and mean differences for continuous data. MAIN RESULTS 12 trials were included with a total of 8578 randomized participants. TB preventive therapy (any anti-TB drug) versus placebo was associated with a lower incidence of active TB (RR 0.68, 95% CI 0.54 to 0.85). This benefit was more pronounced in individuals with a positive tuberculin skin test (RR 0.38, 95% CI 0.25 to 0.57) than in those who had a negative test (RR 0.89, 95% CI 0.64 to 1.24). Efficacy was similar for all regimens (regardless of drug type, frequency or duration of treatment). However, compared to INH monotherapy, short-course multi-drug regimens were much more likely to require discontinuation of treatment due to adverse effects. Although there was reduction in mortality with INH monotherapy versus placebo among individuals with a positive tuberculin skin test (RR 0.74, 95% CI 0.55 to 1.00) and with INH plus rifampicin versus placebo regardless of tuberculin skin test status (RR 0.69, 95% CI 0.50 to 0.95), overall, there was no evidence that TB preventive therapy versus placebo reduced all-cause mortality (RR 0.94, 95% CI 0.85 to 1.05). AUTHORS' CONCLUSIONS Treatment of latent tuberculosis infection reduces the risk of active TB in HIV positive individuals especially in those with a positive tuberculin skin test. The choice of regimen will depend on factors such as availability, cost, adverse effects, adherence and drug resistance. Future studies should assess these aspects. In addition, trials evaluating the long-term effects of anti-tuberculosis chemoprophylaxis, the optimal duration of TB preventive therapy, the influence of level of immunocompromise on effectiveness and combination of anti-tuberculosis chemoprophylaxis with antiretroviral therapy are needed.
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Affiliation(s)
| | - Ifedayo Adetifa
- Medical Research Council (UK) LaboratoriesBacterial Diseases ProgrammeAtlantic Boulevard, FajaraPO Box 273BanjulGambia
| | - Sasha Shepperd
- University of OxfordDepartment of Public HealthOxfordUKOX3 7LF
| | - Jimmy Volmink
- Stellenbosch UniversityFaculty of Health SciencesPO Box 19063TygerbergSouth Africa7505
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Sánchez F, Balagué M, García de Olalla P, López Colomés JL, Martín V, Guerrero R, Marco A, Caylà JA. Treatment of latent Mycobacterium tuberculosis infection in intravenous drug users co-infected with HIV. J Infect Prev 2010. [DOI: 10.1177/1757177409354732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This clinical trial, carried out among injection drug users and the HIV-infected with tuberculin skin test ≥ 5 mm, aimed to evaluate the compliance and tolerability of two preventive strategies against tuberculosis (TB). Methods: Study protocol prospectively compares adherence to nine months of daily therapy with isoniazid (9H) versus two months of daily therapy with rifampin plus pyrazinamide (2RZ) administered randomly. All patients were concurrently admitted to a methadone maintenance programme. To assess toxicity, liver function was monitored monthly. Results: From 305 assessable patients, those in 2RZ arm showed better adherence (84% vs. 59%, p < 0.0001). Results on liver toxicity did not show significant differences between 9H and 2RZ (4.5% vs. 6.9%; odds ratio = 1.58, 95% confidence interval = 0.42—7.24). Conclusion: 2RZ should be considered an option to prevent TB in selected groups of patients infected with HIV, such as injection drug users on methadone treatment.
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Affiliation(s)
- Francesca Sánchez
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar, Paseo Marítimo, 25-29, 08003, Barcelona, Spain,
| | - Montse Balagué
- Unitat d'Investigació en Tuberculosi de Barcelona (UITB). Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Patricia García de Olalla
- Unitat d'Investigació en Tuberculosi de Barcelona (UITB). Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - José L. López Colomés
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar, Paseo Marítimo, 25-29, 08003, Barcelona, Spain
| | | | | | | | - Joan A. Caylà
- Unitat d'Investigació en Tuberculosi de Barcelona (UITB). Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
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Date AA, Vitoria M, Granich R, Banda M, Fox MY, Gilks C. Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV. Bull World Health Organ 2009; 88:253-9. [PMID: 20431788 DOI: 10.2471/blt.09.066522] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/16/2009] [Accepted: 07/20/2009] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To measure progress in implementing co-trimoxazole prophylaxis (CTXp) (trimethoprim plus sulfamethoxazole) and isoniazid preventive therapy (IPT) policy recommendations, identify barriers to the development of national policies and pinpoint challenges to implementation. METHODS In 2007 we conducted by e-mail a cross-sectional survey of World Health Organization (WHO) HIV/AIDS programme officers in 69 selected countries having a high burden of infection with HIV or HIV-associated tuberculosis (TB). The specially-designed, self-administered questionnaire contained items covering national policies for CTXp and IPT in people living with HIV, current level of implementation and barriers to developing or implementing these policies. FINDINGS The 41 (59%) respondent countries, representing all WHO regions, comprised 85% of the global burden of HIV-associated TB and 82% of the global burden of HIV infection. Thirty-eight countries (93%) had an established national policy for CTXp, but only 66% of them (25/38) had achieved nationwide implementation. For IPT, 21 of 41 countries (51%) had a national policy but only 28% of them (6/21) had achieved nationwide implementation. Despite significant progress in the development of CTXp policy, the limited availability of co-trimoxazole for this indication and inadequate systems to manage drug supply impeded nationwide implementation. Inadequate intensified tuberculosis case-finding and concerns regarding isoniazid resistance were challenges to the development and implementation of national IPT policies. CONCLUSION Despite progress in implementing WHO-recommended CTXp and IPT policies, these interventions remain underused. Urgent steps are required to facilitate the development and implementation of these policies.
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Affiliation(s)
- Anand A Date
- Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
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T-cell interferon-gamma release assays for the rapid immunodiagnosis of tuberculosis: clinical utility in high-burden vs. low-burden settings. Curr Opin Pulm Med 2009; 15:188-200. [PMID: 19387262 DOI: 10.1097/mcp.0b013e32832a0adc] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The utility of T-cell interferon-gamma (IFN-gamma) responses to Mycobacterium tuberculosis specific antigens [interferon-gamma release assays (IGRAs)] in high-burden settings remains unclear and there is growing evidence that IGRA performance varies across high tuberculosis (TB) burden vs. low TB burden settings. Here we review the evidence supporting the utility of IGRAs in specific subgroups and compare their performance in high-burden vs. low-burden settings. RECENT FINDINGS Although the IGRA, compared with the tuberculin skin test (TST), has greater specificity in BCG-vaccinated individuals, treatment of latent tuberculosis infection is not a priority in high-burden setting. Nevertheless, in high-burden settings, the TST performs reasonably well and correlates as well, or better, with proxy measures of exposure. SUMMARY IGRAs may still be useful in high-burden settings in specific subgroups at high risk of progression, including young children, HIV-infected individuals and healthcare workers, but this requires confirmation. Although the IGRAs cannot distinguish between latent and active TB, their utility as rule-out tests, when combined with smear microscopy or the TST, requires further study. Prospective studies are required in high-burden settings to confirm whether IFN-gamma responses are predictive of high risk of progression to active TB, particularly in HIV-infected individuals.
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Deiss RG, Rodwell TC, Garfein RS. Tuberculosis and illicit drug use: review and update. Clin Infect Dis 2009; 48:72-82. [PMID: 19046064 DOI: 10.1086/594126] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Illicit drug users continue to be a group at high risk for tuberculosis (TB). Here, we present an updated review of the relationship between TB and illicit drug use, and we summarize more than a decade of new research. Drug users, and injection drug users in particular, have driven TB epidemics in a number of countries. The successful identification and treatment of TB among illicit drug users remain important components of a comprehensive TB strategy, but illicit drug users present a unique set of challenges for TB diagnosis and control. New diagnostic modalities, including interferon-gamma-release assays, offer potential for improved diagnosis and surveillance among this group, along with proven treatment strategies that incorporate the use of directly observed therapy with treatment for drug abuse. Special considerations, including coinfection with viral hepatitis and the rifampin-methadone drug interaction, warrant clinical attention and are also updated here.
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Affiliation(s)
- Robert G Deiss
- University of California, San Diego, La Jolla, California, USA
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Miró JM. Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH en el año 2008. Enferm Infecc Microbiol Clin 2008; 26:437-64. [DOI: 10.1157/13125642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stout JE, Menzies D. Predicting tuberculosis: does the IGRA tell the tale? Am J Respir Crit Care Med 2008; 177:1055-7. [PMID: 18460459 DOI: 10.1164/rccm.200802-251ed] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Churchyard GJ, Scano F, Grant AD, Chaisson RE. Tuberculosis preventive therapy in the era of HIV infection: overview and research priorities. J Infect Dis 2007; 196 Suppl 1:S52-62. [PMID: 17624827 DOI: 10.1086/518662] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The recognition of tuberculosis (TB) as a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons has led to renewed interest in TB preventive therapy and its incorporation into the essential package of health care for these individuals. Despite convincing data regarding its efficacy, TB preventive therapy has not been widely implemented. Further work is needed to determine how to overcome the barriers to the implementation of such therapy, including how best to exclude the presence of active TB before providing preventive therapy. Such issues as the optimal duration of preventive therapy for and the role of TB preventive therapy in the treatment of individuals receiving antiretroviral therapy remain to be defined. Ongoing research will help to determine how best to use this intervention in the care of HIV-infected persons and in the control of TB on a wider basis.
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Golub JE, Saraceni V, Cavalcante SC, Pacheco AG, Moulton LH, King BS, Efron A, Moore RD, Chaisson RE, Durovni B. The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS 2007; 21:1441-8. [PMID: 17589190 PMCID: PMC3063947 DOI: 10.1097/qad.0b013e328216f441] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tuberculosis is a common complication and leading cause of death in HIV infection. Antiretroviral therapy (ART) lowers the risk of tuberculosis, but may not be sufficient to control HIV-related tuberculosis. Isoniazid preventive therapy (IPT) reduces tuberculosis incidence significantly, but is not widely used. METHODS We analysed tuberculosis incidence in 11 026 HIV-infected patients receiving medical care at 29 public clinics in Rio de Janeiro, Brazil, between 1 September 2003 and 1 September 2005. Data were collected through a retrospective medical record review. We determined rates of tuberculosis in patients who received neither ART nor IPT, only ART, only IPT, or both ART and IPT. RESULTS The overall tuberculosis incidence was 2.28 cases/100 person-years (PY) [95% confidence interval (CI) 2.06-2.52]. Among patients who received neither ART nor IPT, incidence was 4.01/100 PY. Patients who received ART had an incidence of 1.90/100 PY (95% CI 1.66-2.17) and those treated with IPT had a rate of 1.27/100 PY (95% CI 0.41-2.95). The incidence among patients who received ART and IPT was 0.80/100 PY (95% CI 0.38-1.47). Multivariate Cox proportional hazards modeling revealed a 76% reduction in tuberculosis risk among patients receiving both ART and IPT (adjusted relative hazard 0.24; P < 0.001) after adjusting for age, previous tuberculosis diagnosis, and CD4 cell counts at baseline. CONCLUSION The use of both IPT and ART in HIV-infected patients is associated with significantly reduced tuberculosis incidence. In conjunction with expanded access to ART, the wider use of IPT in patients with HIV will improve tuberculosis control in high burden areas.
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Affiliation(s)
- Jonathan E. Golub
- Center for Tuberculosis Research and Departments of Medicine and International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Solange C. Cavalcante
- Municipal Health Secretariat, Rio de Janeiro, Brazil
- Fiocruz, Rio de Janeiro and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio G. Pacheco
- Municipal Health Secretariat, Rio de Janeiro, Brazil
- Fiocruz, Rio de Janeiro and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lawrence H. Moulton
- Center for Tuberculosis Research and Departments of Medicine and International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bonnie S. King
- Center for Tuberculosis Research and Departments of Medicine and International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne Efron
- Center for Tuberculosis Research and Departments of Medicine and International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard D. Moore
- Center for Tuberculosis Research and Departments of Medicine and International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard E. Chaisson
- Center for Tuberculosis Research and Departments of Medicine and International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Betina Durovni
- Municipal Health Secretariat, Rio de Janeiro, Brazil
- Fiocruz, Rio de Janeiro and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Bress JN, Hulgan T, Lyon JA, Johnston CP, Lehmann H, Sterling TR. Agreement of decision analyses and subsequent clinical studies in infectious diseases. Am J Med 2007; 120:461.e1-9. [PMID: 17466659 PMCID: PMC1909755 DOI: 10.1016/j.amjmed.2006.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 07/13/2006] [Accepted: 08/08/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Decision analysis techniques can compare management strategies when there are insufficient data from clinical studies to guide decision making. We compared the outcomes of decision analyses and subsequent clinical studies in the infectious disease literature to assess the validity of the conclusions of the decision analyses. METHODS A search strategy to identify decision analyses in infectious disease topics published from 1990 to 2005 was developed and performed using PubMed. Abstracts of all identified articles were reviewed, and infectious disease-related decision analyses were retained. Subsequent clinical trials and observational studies that corresponded to these decision analyses were identified using prespecified search strategies. Clinical studies were considered a match for the decision analysis if they assessed the same patient population, intervention, and outcome. Agreement or disagreement between the conclusions of the decision analysis and clinical study were determined by author review. RESULTS The initial PubMed search yielded 318 references. Forty decision analyses pertaining to 29 infectious disease topics were identified. Of the 40, 16 (40%) from 13 infectious disease topics had matching clinical studies. In 12 of 16 (75%), conclusions of at least 1 clinical study agreed with those of the decision analysis. Three of the 4 decision analyses in which conclusions disagreed were from the same topic (management of febrile children). CONCLUSIONS There was substantial agreement between the conclusions of decision analyses and clinical studies in infectious diseases, supporting the validity of decision analysis and its utility in guiding management decisions.
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Affiliation(s)
| | - Todd Hulgan
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN
- Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN
| | - Jennifer A. Lyon
- Eskind Biomedical Library, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Harold Lehmann
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy R. Sterling
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN
- Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN
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Balcells ME, Thomas SL, Godfrey-Faussett P, Grant AD. Isoniazid preventive therapy and risk for resistant tuberculosis. Emerg Infect Dis 2006; 12:744-51. [PMID: 16704830 PMCID: PMC3374455 DOI: 10.3201/eid1205.050681] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In the context of tuberculosis (TB) resurgence, isoniazid preventive therapy (IPT) is increasingly promoted, but concerns about the risk for development of isoniazid-resistant tuberculosis may hinder its widespread implementation. We conducted a systematic review of data published since 1951 to assess the effect of primary IPT on the risk for isoniazid-resistant TB. Different definitions of isoniazid resistance were used, which affected summary effect estimates; we report the most consistent results. When all 13 studies (N = 18,095 persons in isoniazid groups and N = 17,985 persons in control groups) were combined, the summary relative risk for resistance was 1.45 (95% confidence interval 0.85-2.47). Results were similar when studies of HIV-uninfected and HIV-infected persons were considered separately. Analyses were limited by small numbers and incomplete testing of isolates, but findings do not exclude an increased risk for isoniazid-resistant TB after IPT. The diagnosis of active TB should be excluded before IPT. Continued surveillance for isoniazid resistance is essential.
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Affiliation(s)
| | - Sara L. Thomas
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Alison D. Grant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
INTRODUCTION Tuberculosis continues to be a major cause of morbidity and mortality worldwide. Currently available drugs are effective for treatment of the disease or latent infection, but may cause serious adverse effects. METHODS The authors reviewed the literature for side effects of five first-line antituberculous medications (isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin). Incidence of the major side effects were compiled with particular attention to the incidence of isoniazid hepatotoxicity. RESULTS Hepatotoxicity to isoniazid is a serious problem. Although overall incidence may be decreasing, incidence averaged 9.2 per 1000 patients who were compliant, in multiple studies, with a case fatality rate of 4.7%. The incidence is higher with increasing age. Other serious adverse effects include dermatological, gastrointestinal, hypersensitivity, neurological, haematological and renal reactions. They can lead to drug discontinuation (in up to 10% of patients) or even more serious morbidity or mortality. CONCLUSIONS Side effects to antituberculosis drugs are common, and include hepatitis, cutaneous reactions, gastrointestinal intolerance, haematological reactions and renal failure. These adverse effects must be recognised early, to reduce associated morbidity and mortality.
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Affiliation(s)
- Eric J Forget
- Respiratory Epidemiology Unit, Montreal Chest Institute, McGill University, Montréal, Québec, H2X 2P4, Canada
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