Isoniazid tuberculosis preventive therapy in HIV-infected adults accessing antiretroviral therapy: a Botswana Experience, 2004-2006.
OBJECTIVE
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.
Mosimaneotsile
Barudi
B
BOTUSA, Gaborone and Francistown, Botswana.
Mathoma
Anikie
A
Chengeta
Bafanana
B
Nyirenda
Samba
S
Agizew
Tefera B
TB
Tedla
Zegabriel
Z
Motsamai
Oaitse I
OI
Kilmarx
Peter H
PH
Wells
Charles D
CD
Samandari
Taraz
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001902:Botswana; D018890:Chemoprevention / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014376:Tuberculosis / Q000517:prevention & control*; D055815:Young Adult; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D007538:Isoniazid