Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations.
In sub-Saharan Africa, where the emergence of HIV has caused dramatic increases in tuberculosis (TB) case notifications, new strategies for TB control are necessary. Isoniazid preventive therapy (IPT) for HIV-TB coinfected individuals reduces the reactivation of latent Mycobacterium tuberculosis infections and is being evaluated as a potential community-wide strategy for improving TB control. We developed a mathematical model of TB/HIV coepidemics to examine the impact of community-wide implementation of IPT for TB-HIV coinfected individuals on the dynamics of drug-sensitive and -resistant TB epidemics. We found that community-wide IPT will reduce the incidence of TB in the short-term but may also speed the emergence of drug-resistant TB. We conclude that community-wide IPT in areas of emerging HIV and drug-resistant TB should be coupled with diagnostic and treatment policies designed to identify and effectively treat the increasing proportion of patients with drug-resistant TB.
Cohen
Ted
T
Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, Boston, MA 02120, USA. tcohen@hsph.harvard.edu
Lipsitch
Marc
M
Walensky
Rochelle P
RP
Murray
Megan
M
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D017954:Africa South of the Sahara / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008962:Models, Theoretical; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
D000995:Antitubercular Agents; D007538:Isoniazid