Tuberculosis preventive therapy

An underutilized strategy to reduce individual risk of TB and contribute to TB control

G. J. Churchyard, Richard E Chaisson, G. Maartens, H. Getahun

Research output: Contribution to journalArticle

Abstract

Tuberculosis (TB) remains a global health problem, and South Africa (SA) has one of the world's worst TB epidemics. The World Health Organization (WHO) estimated in 1999 that one-third of the world's population was latently infected with TB. In SA up to 88% of HIVuninfected young adults (31 - 35 years) are latently infected with TB. In the most recent meta-analysis, 6 - 12 months of isoniazid prevsentive therapy (IPT) was associated with a lower incidence of active TB than placebo (relative risk (RR) 0.68; 95% confidence interval (CI) 0.54 - 0.85), with the greatest benefit among individuals with a positive tuberculin skin test (TST) (RR 0.38; 95% CI 0.25 - 0.57). A clinical trial of IPT given with antiretroviral therapy (ART) for 12 months reduced TB incidence by 37% compared with ART alone (hazard ratio (HR) 0.63; 95% CI 0.41 - 0.94). The effect of IPT is limited in high-burden countries. IPT for 36 months v. 6 months reduced TB incidence among HIVpositive, TST-positive participants by 74% (HR 0.26; 95% CI 0.09 - 0.80). A study of more than 24 000 goldminers confirmed that IPT is safe, with only 0.5% experiencing adverse events. A meta-analysis of studies of IPT since 1951 did not show an increased risk of developing resistance. Alternative TB preventive therapy regimens, including high-dose isoniazid and rifapentine given weekly for 3 months, have been shown to have similar efficacy to IPT. Mathematical modelling suggests that scaling up continuous IPT targeted to HIV-positive persons, when used in combination with other treatment and prevention strategies, may substantially improve TB control.

Original languageEnglish (US)
Pages (from-to)339-343
Number of pages5
JournalSouth African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
Volume104
Issue number5
DOIs
StatePublished - 2014

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Isoniazid
Tuberculosis
Therapeutics
Confidence Intervals
Tuberculin Test
rifapentine
South Africa
Skin Tests
Meta-Analysis
Incidence
Young Adult
Placebos
Clinical Trials
HIV

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Tuberculosis preventive therapy: An underutilized strategy to reduce individual risk of TB and contribute to TB control",
abstract = "Tuberculosis (TB) remains a global health problem, and South Africa (SA) has one of the world's worst TB epidemics. The World Health Organization (WHO) estimated in 1999 that one-third of the world's population was latently infected with TB. In SA up to 88{\%} of HIVuninfected young adults (31 - 35 years) are latently infected with TB. In the most recent meta-analysis, 6 - 12 months of isoniazid prevsentive therapy (IPT) was associated with a lower incidence of active TB than placebo (relative risk (RR) 0.68; 95{\%} confidence interval (CI) 0.54 - 0.85), with the greatest benefit among individuals with a positive tuberculin skin test (TST) (RR 0.38; 95{\%} CI 0.25 - 0.57). A clinical trial of IPT given with antiretroviral therapy (ART) for 12 months reduced TB incidence by 37{\%} compared with ART alone (hazard ratio (HR) 0.63; 95{\%} CI 0.41 - 0.94). The effect of IPT is limited in high-burden countries. IPT for 36 months v. 6 months reduced TB incidence among HIVpositive, TST-positive participants by 74{\%} (HR 0.26; 95{\%} CI 0.09 - 0.80). A study of more than 24 000 goldminers confirmed that IPT is safe, with only 0.5{\%} experiencing adverse events. A meta-analysis of studies of IPT since 1951 did not show an increased risk of developing resistance. Alternative TB preventive therapy regimens, including high-dose isoniazid and rifapentine given weekly for 3 months, have been shown to have similar efficacy to IPT. Mathematical modelling suggests that scaling up continuous IPT targeted to HIV-positive persons, when used in combination with other treatment and prevention strategies, may substantially improve TB control.",
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