Details:

Alternative Title:
J Acquir Immune Defic Syndr
Personal Author:
Briggs, Melissa A. ; Emerson, Courtney ; Modi, Surbhi ; Taylor, Nicholas Kenji ; Date, Anand
Briggs, Melissa A. ; Emerson, Courtney ; Modi, Surbhi ; Taylor, Nicholas Kenji ; Date, Anand Less -
Description:
Background

Tuberculosis (TB) is the leading preventable cause of death in persons living with HIV (PLHIV), accounting for over a quarter of all HIV-associated deaths in 2012. Isoniazid preventive therapy (IPT) has the potential to decrease TB-related cases and deaths in PLHIV; however, implementation of this has been slow in many high HIV- and TB-burden settings.

Methodology

We performed an assessment of the evidence for the use of IPT in adults living with HIV based on a review of literature published from 1995 to 2013. Eligible articles included data on mortality, morbidity, or retention in care related to the provision of IPT to adults with HIV in low- or middle-income countries. Cost-effectiveness information was also abstracted.

Results

We identified 41 articles involving over 45,000 persons living with HIV. While there was little evidence to demonstrate that IPT reduced mortality in PLHIV, there was substantial evidence that IPT reduced TB incidence. While these findings were consistent irrespective of CD4 or antiretroviral therapy (ART) status, studies frequently demonstrated a greater benefit among patients with a positive TB skin test (TST). Duration of effectiveness and benefits of prolonged therapy varied across settings.

Conclusions

This analysis supports the WHO recommendations for the provision of IPT to PLHIV to reduce TB associated morbidity, and serves to highlight the need to strengthen IPT implementation. While there appears to be a greater benefit of IPT among PLHIV who are TST positive, IPT should be provided to all PLHIV without presumptive TB when TST is not available.


Subjects:
[+]
Adult Antitubercular Agents Article CD4 Lymphocyte Count Developing Countries Health Resources HIV Infections Humans Isoniazid Tuberculosis
Source:
J Acquir Immune Defic Syndr. 68(Suppl 3):S297-S305
Pubmed ID:
25768869
Pubmed Central ID:
PMC6381831
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States ; PEPFAR/United States
CC999999/Intramural CDC HHS/United States ; PEPFAR/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:19f4483169a5ce58d6a6625b3846a776333c5b7f627f7ceaed7e2aa962d50ee4
Download URL:
https://stacks.cdc.gov/view/cdc/76113/cdc_76113_DS1.pdf
File Type:

Supporting Files

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