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. 2018 Apr 1;77(4):405-412.
doi: 10.1097/QAI.0000000000001610.

Isoniazid Preventive Therapy for People With HIV Who Are Heavy Alcohol Drinkers in High TB-/HIV-Burden Countries: A Risk-Benefit Analysis

J Morgan Freiman  1 , Karen R Jacobson  1   2 , Winnie R Muyindike  3   4 , C Robert Horsburgh  2 , Jerrold J Ellner  1 , Judith A Hahn  5 , Benjamin P Linas  1   2
Affiliations

Isoniazid Preventive Therapy for People With HIV Who Are Heavy Alcohol Drinkers in High TB-/HIV-Burden Countries: A Risk-Benefit Analysis

J Morgan Freiman et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Isoniazid preventive therapy (IPT) reduces mortality among people living with HIV (PLHIV) and is recommended for those without active tuberculosis (TB) symptoms. Heavy alcohol use, however, is contraindicated for liver toxicity concerns. We evaluated the risks and benefits of IPT at antiretroviral therapy (ART) initiation to ART alone for PLHIV who are heavy drinkers in 3 high TB-/HIV-burden countries.

Methods: We developed a Markov simulation model to compare ART alone to ART with either 6 or 36 months of IPT for heavy drinking PLHIV enrolling in care in Brazil, India, and Uganda. Outcomes included nonfatal toxicity, fatal toxicity, life expectancy, TB cases, and TB death.

Results: In this simulation, 6 months of IPT + ART (IPT6) extended life expectancy over both ART alone and 36 months of IPT + ART (IPT36) in India and Uganda, but ART alone dominated in Brazil in 51.5% of simulations. Toxicity occurred in 160/1000 persons on IPT6 and 415/1000 persons on IPT36, with fatal toxicity in 8/1000 on IPT6 and 21/1000 on IPT36. Sensitivity analyses favored IPT6 in India and Uganda with high toxicity thresholds.

Conclusions: The benefits of IPT for heavy drinkers outweighed its risks in India and Uganda when given for a 6-month course. The toxicity/efficacy trade-off was less in Brazil where TB incidence is lower. IPT6 resulted in fatal toxicity in 8/1000 people, whereas even higher toxicities of IPT36 negated its benefits in all countries. Data to better characterize IPT toxicity among HIV-infected drinkers are needed to improve guidance.

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Conflict of interest statement

Conflicts of interest: none to report

Figures

Figure 1
Figure 1
One-way sensitivity analyses of the threshold probability of isoniazid preventive therapy (IPT) toxicity at the initiation of antiretroviral therapy (ART) compared to the base case estimate and American Thoracic Society (ATS) estimate among people with HIV infection who heavily consume alcohol in a) Brazil b) India and c) Uganda.
Figure 2
Figure 2
Two-way sensitivity analyses of the monthly probability of death from tuberculosis (TB) disease and monthly TB disease incidence per 1000 people during the first 3 months of ART among people with HIV infection who heaviliy consume alcohol in a) Brazil b) India and c) Uganda.
Figure 3
Figure 3
Histograms depicting strategy selection frequency of antiretroviral therapy (ART) plus six-months of isoniazid preventive therapy (IPT), ART plus 36-months of IPT, or ART alone from probabilistic sensitivity analyses of a model simulating a cohort of people living with HIV who heavily consume alcohol enrolling in care in a) Brazil b) India, and c) Uganda.
See this image and copyright information in PMC

References

    1. World Health Organization. Global Tuberculosis Report 2015. Geneva:
    1. Liu E, Makubi A, Drain P, et al. Tuberculosis incidence rate and risk factors among HIV-infected adults with access to antiretroviral therapy. Aids. 2015;29(11):1391–1399. - PMC - PubMed
    1. Van Rie A, Westreich D, Sanne I. Tuberculosis in patients receiving antiretroviral treatment: incidence, risk factors, and prevention strategies. J Acquir Immune Defic Syndr. 2011;56(4):349–355. - PMC - PubMed
    1. Ayele HT, Mourik MS, Debray TP, Bonten MJ. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults: A Systematic Review and Meta-Analysis of Randomized Trials. PLoS One. 2015;10(11):e0142290. - PMC - PubMed
    1. Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database of Systematic Reviews. 2010;(Issue 1) doi: 10.1002/14651858.CD000171.pub3. Art. No.: CD000171. In. - DOI - PMC - PubMed

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