title: Feasibility and efficacy of isoniazid prophylaxis for latent tuberculosis in HIV-infected clients patients in Thailand.
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.
authors: Thai Red Cross AIDS Research Centre, Bangkok, Thailand. mana.k@chula.ac.th
authors: Mana
authors: M
authors: Khongphatthanayothin
authors: Anchalee
authors: A
authors: Avihingsanon
authors: Nipat
authors: N
authors: Teeratakulpisarn
authors: Nittaya
authors: N
authors: Phanuphak
authors: Raksakul
authors: R
authors: Buajoom
authors: Pilin
authors: P
authors: Suwanmala
authors: Praphan
authors: P
authors: Phanuphak
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D014374:Tuberculin Test
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid