Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Feb 15;60(4):639-45.
doi: 10.1093/cid/ciu849. Epub 2014 Nov 2.

Long-term protection from isoniazid preventive therapy for tuberculosis in HIV-infected patients in a medium-burden tuberculosis setting: the TB/HIV in Rio (THRio) study

Jonathan E Golub  1 , Silvia Cohn  1 , Valeria Saraceni  2 , Solange C Cavalcante  3 , Antonio G Pacheco  4 , Lawrence H Moulton  5 , Betina Durovni  6 , Richard E Chaisson  1
Affiliations

Long-term protection from isoniazid preventive therapy for tuberculosis in HIV-infected patients in a medium-burden tuberculosis setting: the TB/HIV in Rio (THRio) study

Jonathan E Golub et al. Clin Infect Dis. .

Abstract

Background: The duration of protection against tuberculosis provided by isoniazid preventive therapy is not known for human immunodeficiency virus (HIV)-infected individuals living in settings of medium tuberculosis incidence.

Methods: We conducted an individual-level analysis of participants in a cluster-randomized, phased-implementation trial of isoniazid preventive therapy. HIV-infected patients who had positive tuberculin skin tests (TSTs) were followed until tuberculosis diagnosis, death, or administrative censoring. Nelson-Aalen cumulative hazard plots were generated and hazards were compared using the log-rank test. Cox proportional hazards models were fitted to investigate factors associated with tuberculosis diagnosis.

Results: Between 2003 and 2009, 1954 patients with a positive TST were studied. Among these, 1601 (82%) initiated isoniazid. Overall tuberculosis incidence was 1.39 per 100 person-years (PY); 0.53 per 100 PY in those who initiated isoniazid and 6.52 per 100 PY for those who did not (adjusted hazard ratio [aHR], 0.17; 95% confidence interval [CI], .11-.25). Receiving antiretroviral therapy at time of a positive TST was associated with a reduced risk of tuberculosis (aHR, 0.69; 95% CI, .48-1.00). Nelson-Aalen plots of tuberculosis incidence showed a constant risk, with no acceleration in 7 years of follow-up for those initiating isoniazid preventive therapy.

Conclusions: Isoniazid preventive therapy significantly reduced tuberculosis risk among HIV-infected patients with a positive TST. In a medium-prevalence setting, 6 months of isoniazid in HIV-infected patients with positive TST reduces tuberculosis risk over 7 years of follow-up, in contrast to results of studies in higher-burden settings in Africa.

Keywords: HIV; durability; isoniazid; preventive therapy; tuberculosis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Nelson–Aalen plots of tuberculosis incidence for patients starting and those not starting isoniazid preventive therapy (IPT). Abbreviation: TST, tuberculin skin test.
See this image and copyright information in PMC

References

    1. Comstock GW, Baum C, Snider DE., Jr Isoniazid prophylaxis among Alaskan Eskimos: a final report of the Bethel isoniazid studies. Am Rev Respir Dis. 1979;119:827–30. - PubMed
    1. Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2010 CD000171. - PMC - PubMed
    1. World Health Organization . Geneva, Switzerland: WHO; 2013. Global tuberculosis report 2013. WHO/HTM/2013.11.
    1. Pape JW, Jean SS, Ho JL, Hafner A, Johnson WD., Jr Effect of isoniazid prophylaxis on incidence of active tuberculosis and progression of HIV infection. Lancet. 1993;342:268–72. - PubMed
    1. de Pinho AM, Santoro-Lopes G, Harrison LH, Schechter M. Chemoprophylaxis for tuberculosis and survival of HIV-infected patients in Brazil. AIDS. 2001;15:2129–35. - PubMed

Publication types