title: Continuous isoniazid for the treatment of latent tuberculosis infection in people living with HIV.
abstract: OBJECTIVE
  This systematic review was carried out to determine the effectiveness of continuous isoniazid (given for at least 36 months) for the treatment of latent tuberculosis infection (LTBI) in people living with HIV (PLHIV).
  
  
  METHODS
  Six databases and HIV and tuberculosis (TB) conference abstract books were searched for randomized controlled trials that compared the effectiveness of continuous isoniazid with 6 months of isoniazid. Outcomes of interest were TB incidence, mortality, adverse events and risk of drug resistance. Data were pooled using fixed-effects meta-analysis.
  
  
  RESULTS
  Three studies were included, from Botswana, South Africa and India. The risk of active TB was 38% lower among patients receiving continuous isoniazid compared with isoniazid regimen for 6 months [relative risk (RR) 0.62, 95% confidence interval (CI): 0.42-0.89; I = 0%], and 49% lower for those with a positive tuberculin skin test (TST) (RR 0.51, 95% CI: 0.30-0.86; I = 7%). Similarly, individuals with positive TST had a 50% lower chance of death (RR 0.50, 95% CI: 0.27-0.91; I = 3%). Two studies found no evidence of an increase in adverse events in the continuous isoniazid group, whereas a third study, that used a different definition for adverse events, found strong evidence of increase. There was no evidence of increased drug resistance when continuous isoniazid was given.
  
  
  CONCLUSIONS
  For PLHIV in settings with high TB and HIV prevalence and transmission, continuous isoniazid for at least 36 months is beneficial and probably outweighs the risk of increased adverse events compared with an isoniazid regimen for 6 months.
authors.affiliation: aIndependent Consultant bThe Global TB Programme, World Health Organization cDepartment of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Saskia
authors.initials: S
authors.lastname: Den Boon
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Haileyesus
authors.initials: H
authors.lastname: Getahun
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D001902:Botswana; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007194:India; D007538:Isoniazid / Q000008:administration & dosage*; D055985:Latent Tuberculosis / Q000188:drug therapy*; D013019:South Africa; D016896:Treatment Outcome
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid