Tuberculosis Preventive Therapy for People With HIV Infection in High Tuberculosis Burden Settings: How Much Is Enough?

EditorialsOctober 2021Tuberculosis Preventive Therapy for People With HIV Infection in High Tuberculosis Burden Settings: How Much Is Enough?Rebecca H. Berhanu, MD and Karen R. Jacobson, MD, MPHRebecca H. Berhanu, MDBoston University School of Public Health, Boston, MassachusettsSearch for more papers by this author and Karen R. Jacobson, MD, MPHBoston University School of Medicine, Boston, MassachusettsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3170 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Prior trials have suggested that people with HIV infection who are living in settings with high tuberculosis (TB) burden benefit from longer courses of TB preventive therapy (TPT), in part to avert reinfection (1, 2). The World Health Organization (WHO) guidance that individuals with HIV infection in these settings receive 36 months of isoniazid-based TPT has not been widely implemented, owing to poor completion rates of even 6 to 12 months and hepatotoxicity concerns, as well as the fact that the largest benefit is observed in those with a positive result on a latent TB infection test, which is not ...References1. Samandari T, Agizew TB, Nyirenda S, et al. 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, double-blind, placebo-controlled trial. Lancet. 2011;377:1588-98. [PMID: 21492926] doi:10.1016/S0140-6736(11)60204-3 CrossrefMedlineGoogle Scholar2. den Boon S, Matteelli A, Ford N, et al. Continuous isoniazid for the treatment of latent tuberculosis infection in people living with HIV. AIDS. 2016;30:797-801. [PMID: 26730567] doi:10.1097/QAD.0000000000000985 CrossrefMedlineGoogle Scholar3. World Health Organization. WHO Consolidated Guidelines on Tuberculosis. Module 1: Prevention—Tuberculosis Preventive Treatment. World Health Organization; 2020. Accessed at www.who.int/publications/i/item/9789240001503 on 29 July 2021. Google Scholar4. Rangaka MX, Wilkinson RJ, Boulle A, et al. Isoniazid plus antiretroviral therapy to prevent tuberculosis: a randomised double-blind, placebo-controlled trial. Lancet. 2014;384:682-90. [PMID: 24835842] doi:10.1016/S0140-6736(14)60162-8 CrossrefMedlineGoogle Scholar5. Sterling TR, Villarino ME, Borisov AS, et al; TB Trials Consortium PREVENT TB Study Team. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365:2155-66. [PMID: 22150035] doi:10.1056/NEJMoa1104875 CrossrefMedlineGoogle Scholar6. Churchyard G, Cárdenas V, Chihota V, et al; WHIP3TB Study Team. Annual tuberculosis preventive therapy for persons with HIV infection. A randomized trial. Ann Intern Med. 2021;174:1367-1376. doi:10.7326/M20-7577 Google Scholar7. Drain PK, Bajema KL, Dowdy D, et al. Incipient and subclinical tuberculosis: a clinical review of early stages and progression of infection. Clin Microbiol Rev. 2018;31. [PMID: 30021818] doi:10.1128/CMR.00021-18 CrossrefMedlineGoogle Scholar8. Marx FM, Dunbar R, Enarson DA, et al. The temporal dynamics of relapse and reinfection tuberculosis after successful treatment: a retrospective cohort study. Clin Infect Dis. 2014;58:1676-83. [PMID: 24647020] doi:10.1093/cid/ciu186 CrossrefMedlineGoogle Scholar9. Sonnenberg P, Murray J, Glynn JR, et al. HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: a cohort study in South African mineworkers. Lancet. 2001;358:1687-93. [PMID: 11728545] CrossrefMedlineGoogle Scholar10. den Boon S, Matteelli A, Getahun H. Rifampicin resistance after treatment for latent tuberculous infection: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2016;20:1065-71. [PMID: 27393541] doi:10.5588/ijtld.15.0908 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Boston University School of Public Health, Boston, MassachusettsBoston University School of Medicine, Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3170.Corresponding Author: Karen R. Jacobson, MD, MPH, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118; e-mail, [email protected]edu.Current Author Addresses: Dr. Berhanu: Health Economics Epidemiology Office, University of Witwatersrand, 139 Empire Road, Parktown West, Johannesburg, South Africa 2193.Dr. Jacobson: Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118.This article was published at Annals.org on 24 August 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnual Tuberculosis Preventive Therapy for Persons With HIV Infection Gavin Churchyard , Vicky Cárdenas , Violet Chihota , Kathy Mngadi , Modulakgotla Sebe , William Brumskine , Neil Martinson , Getnet Yimer , Shu-Hua Wang , Alberto L. Garcia-Basteiro , Dinis Nguenha , LeeAnne Masilela , Zainab Waggie , Susan van den Hof , Salome Charalambous , Frank Cobelens , Richard E. Chaisson , Alison D. Grant , Katherine L. Fielding , and Metrics Cited byUnhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern Uganda October 2021Volume 174, Issue 10Page: 1462-1463KeywordsAntiretroviral therapyClinical trialsGlobal healthIsoniazidSerious adverse eventsSputum ePublished: 24 August 2021 Issue Published: October 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...