Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study.
BACKGROUND
Isoniazid preventive therapy (IPT) is a recommended strategy for prevention of tuberculosis (TB) in persons with Human Immunodeficiency Virus (HIV) although the benefits have not been unequivocally demonstrated in routine clinical practice with widespread ART adoption. Therefore, we assessed the effectiveness of IPT in prevention of TB or death in patients treated with antiretroviral therapy (ART) in a chronic care setting.


METHODS
Retrospective cohort study of HIV patients enrolled in chronic care from 2007 to 2013. Eligible participants were HIV infected subjects (age > 15 years) with no (history of) TB. The combined effect of IPT and ART on the composite outcome (TB or death) was estimated using time-dependent Cox regression with adjustment for baseline covariates.


RESULTS
1,922 patients were included, 374 (19.4 %) received IPT and 258 (13.4 %) developed TB or deceased. The median follow-up duration of the cohort was 839 days, with a total of 5491 person years. In unadjusted analysis, the combination of IPT and ART lowered the hazard of TB or death by 65 % [HR = 0.35; 95 % CI (0.16, 0.77)] compared to ART alone. Even after adjustment for confounders, the combined effect of ART and IPT resulted in a 60 % hazard reduction of TB or death in comparison to participants who received ART without IPT [HR = 0.40; 95 % CI (0.18, 0.87)]. The IPT-specific benefit in patients not receiving ART could not be reliably estimated due to high rates of ART adoption.


CONCLUSIONS
The combined effect of IPT and ART to prevent TB or death in HIV patients in a non-experimental setting in comparison to ART alone was estimated to be 60 %.
Julius Center for Health Sciences and Primary Care, Infectious Diseases Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands. h.t.ayele@umcutrecht.nl.|Department of Public Health, Dilla University College of Medicine & Health Sciences and Referral Hospital, Dilla, Gedeo Zone, Ethiopia. h.t.ayele@umcutrecht.nl.
Henok Tadesse
HT
Ayele
Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands. M.S.M.vanMourik-2@umcutrecht.nl.
Maaike S M
MS
van Mourik
Julius Center for Health Sciences and Primary Care, Infectious Diseases Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands. M.J.M.Bonten@umcutrecht.nl.|Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands. M.J.M.Bonten@umcutrecht.nl.
Marc J M
MJ
Bonten
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005002:Ethiopia; D005260:Female; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000627:therapeutic use*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000401:mortality / Q000517:prevention & control*; D055815:Young Adult
D000995:Antitubercular Agents; D007538:Isoniazid