TY - JOUR
T1 - Efficacy of secondary isoniazid preventive therapy among HIV-infected Southern Africans
T2 - Time to change policy?
AU - Churchyard, Gavin J.
AU - Fielding, Katherine
AU - Charalambous, Salome
AU - Day, John H.
AU - Corbett, Elizabeth L.
AU - Hayes, Richard J.
AU - Chaisson, Richard E.
AU - De Cock, Kevin M.
AU - Samb, Badara
AU - Grant, Alison D.
PY - 2003/9/26
Y1 - 2003/9/26
N2 - Objective: To determine the efficacy of secondary preventive therapy against tuberculosis (TB) among gold miners working in South Africa. Design: An observational study. Setting: Health service providing comprehensive care for gold miners. Methods: The incidence of recurrent TB was compared between two cohorts of HIV-infected miners: one cohort (n = 338) had received secondary preventive therapy with isoniazid (IPT) and the other had not (n = 221). Results: The overall incidence of recurrent TB was reduced by 55% among men who received IPT compared with those who did not (incidence rates 8.6 and 19.1 per 100 person-years, respectively; incidence rate ratio, 0.45; 95% confidence interval 0.26-0.78). The efficacy of isoniazid preventive therapy was unchanged after controlling for CD4 cell count and age. The number of person-years of IPT required to prevent one case of recurrent TB among individuals with a CD4 cell count < 200 x 106 cells/I, and ≥ 200 x 106 cells/I was 5 and 19, respectively. Conclusion: Secondary preventive therapy reduces TB recurrence: the absolute impact appears to be greatest among individuals with low CD4 cell counts. International TB preventive therapy guidelines for HIV-infected individuals need to be expanded to include recommendations for secondary preventive therapy in settings where TB prevalence is high.
AB - Objective: To determine the efficacy of secondary preventive therapy against tuberculosis (TB) among gold miners working in South Africa. Design: An observational study. Setting: Health service providing comprehensive care for gold miners. Methods: The incidence of recurrent TB was compared between two cohorts of HIV-infected miners: one cohort (n = 338) had received secondary preventive therapy with isoniazid (IPT) and the other had not (n = 221). Results: The overall incidence of recurrent TB was reduced by 55% among men who received IPT compared with those who did not (incidence rates 8.6 and 19.1 per 100 person-years, respectively; incidence rate ratio, 0.45; 95% confidence interval 0.26-0.78). The efficacy of isoniazid preventive therapy was unchanged after controlling for CD4 cell count and age. The number of person-years of IPT required to prevent one case of recurrent TB among individuals with a CD4 cell count < 200 x 106 cells/I, and ≥ 200 x 106 cells/I was 5 and 19, respectively. Conclusion: Secondary preventive therapy reduces TB recurrence: the absolute impact appears to be greatest among individuals with low CD4 cell counts. International TB preventive therapy guidelines for HIV-infected individuals need to be expanded to include recommendations for secondary preventive therapy in settings where TB prevalence is high.
KW - HIV infection
KW - Isoniazid preventive therapy
KW - Tuberculosis
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U2 - 10.1097/00002030-200309260-00007
DO - 10.1097/00002030-200309260-00007
M3 - Article
C2 - 14502009
AN - SCOPUS:0142061994
SN - 0269-9370
VL - 17
SP - 2063
EP - 2070
JO - AIDS
JF - AIDS
IS - 14
ER -