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. 2022 Dec 21;12(4):153-158.
doi: 10.5588/pha.22.0016.

Breakthrough TB among people living with HIV on TB preventive therapy

S Nyangu  1 , M Kagujje  1 , I Mwaba  1 , D Luhanga  1 , R Hambwalula  1 , S Maliko  1 , T Mushili  1 , E Mwamba  1 , Mukaba Mulai  1 , Monde Muyoyeta  1
Affiliations

Breakthrough TB among people living with HIV on TB preventive therapy

S Nyangu et al. Public Health Action. .

Abstract
in English, French

Background: Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.

Method: This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.

Results: Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4-16).

Conclusion: Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.

Contexte: La Zambie a une incidence de TB estimée à 319/100 000 habitants et une prévalence du VIH de 11,1%. En 2020, seulement 49% des nouvelles personnes vivant avec le VIH (PLVIH) ont reçu une thérapie préventive (TPT) contre la TB en Zambie. Les idées fausses sur la fiabilité du dépistage des symptômes et la résistance aux médicaments chez les personnes qui développent une TB alors qu’elles sont sous TPT sont des obstacles à l’extension de la TPT. Nous avons déterminé l’incidence et les facteurs prédictifs de la découverte de la TB pendant la TPT chez les PLVIH en Zambie.

Méthode: Il s’agissait d’une analyse rétrospective des données du programme TPT de routine chez les PLVIH recueillies entre octobre 2016 et octobre 2019 dans certains établissements de santé primaire en Zambie.

Résultats: Sur 48 581 PLVIH inscrites au programme TPT, 130 (0,3%) ont développé la TB pendant le TPT. Sur ces 130, 90 dossiers de clients ont été consultés. L’âge médian des cas de TB était de 35 ans ; 68% étaient des hommes. Dans l’ensemble, 96% des cas de TB découvert étaient sous traitement antirétroviral (ART) depuis ⩽3 mois; 24% étaient symptomatiques au début du TPT, 22% étaient asymptomatiques et les autres avaient des données manquantes. Parmi les 130 cas de percée de la TB, 79% ont développé la TB au cours du premier mois après le début du TPT. Le délai médian de diagnostic de la TB était de 10 jours (IQR 4–16).

Conclusion: La découverte de la TB pendant le TPT est rare chez les PLVIH sous ART, et très rare après le premier mois du début du TPT. Elle ne devrait donc pas constituer un obstacle à la généralisation des TPT.

Keywords: HIV; IPT; PLHIV; TPT; breakthrough TB.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

FIGURE 1
FIGURE 1
Treatment outcomes of patients initiated on TPT. *Individuals with no outcome. TPT = TB preventive therapy.
FIGURE 2
FIGURE 2
Time to TB incidence. The Kaplan–Meier failure estimates show that there was no association between sex and age with time to TB diagnosis (Figure 3A and 3B). Fifty percent of individuals aged 0–24 years, 25–40 years and >40 years developed TB by Day 25, 7 and 14 after TPT start, respectively. TPT = TB preventive therapy.
FIGURE 3
FIGURE 3
Time to TB diagnosis by patient characteristics. A) Time to TB diagnosis by age category; B) time to TB diagnosis by sex.
See this image and copyright information in PMC

References

    1. World Health Organisation Global tuberculosis report, 2021. Geneva, Switzerland: WHO; 2021.
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    1. World Health Organisation Global tuberculosis report, 2020. Geneva, Switzerland: WHO; 2020.
    1. World Health Organisation Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva, Switzerland: WHO; 2018. - PubMed
    1. Golub JE, et al. The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS. 2007;21(11):1441–1448. - PMC - PubMed

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