Effectiveness and safety of isoniazid chemoprophylaxis for HIV-1 infected patients from Rio de Janeiro

Abstract

The clinical and epidemiological characteristics, adverse events, treatment adherence and effectiveness of isoniazid chemoprophylaxis were analyzed in a cohort of 138 tuberculosis/HIV-coinfected patients. An open, nonrandomized, pragmatic prophylactic trial was conducted on adult patients with a normal chest X-ray and positive tuberculin skin test (≥ 5 mm) who received isoniazid chemoprophylaxis (300 mg/day) for six months. The mean of follow up was 2.8 years (SD 1.3). Adherence to chemoprophylaxis was 87.7% (121/138Several studies have shown that TB chemoprophylaxis reduces the risk of the disease in HIV-infected patients with a positive tuberculin test (induration ≥ 5 mm in diameter) (de Pinho et al. 2001, Grant et al. 2005. One of the strategies to reduce TB among patients with HIV recommended by the World Health Organization (WHO 2007), American Thoracic Society (ATS 2000) and Centers for Disease Control and Prevention (CDC 2003) is the introduction of isoniazid (INH). In the present article, we use the term "TB chemoprophylaxis" since the guidelines of the Brazilian Ministry of Health (MS) for HIV-infected subjects recommend INH monotherapy for 6 months using a dose of 300 mg/day (ATS 2000, MS 2007.In Brazil, one study showed a 3.5 fold increase in the risk of TB in AIDS patients (de Castro Toledo et al. 2000), while another study concluded that TB chemoprophylaxis has an important impact on the survival of HIV-seropositive patients with a positive tuberculin test, reducing the risk of TB by 38%, irrespective of antiretroviral therapy (de Pinho et al. 2001). The use of both INH and antiretroviral therapy in HIV-infected patients is associated with a significantly reduced incidence of TB .Prophylactic trials for TB chemoprophylaxis are still rare in Brazil, a fact supporting the importance of concrete data regarding the effectiveness and safety of this preventive strategy (de Castro Toledo et al. 2000, de Pinho et al. 2001). Thus, the objective of the present study was to describe the clinicalepidemiological and behavioral characteristics, adverse events, adherence to scheduled visits and prescriptions and the effectiveness of TB chemoprophylaxis in a cohort of patients coinfected with HIV and TB. PaTIEnTS, MaTERIaL anD METHODSAn open, non-randomized, pragmatic prophylactic trial regarding INH prophylaxis (300 mg/day) for six months was conducted at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (Fiocruz). The study was approved by the Ethics Committee of IPEC/Fiocruz (protocol 000011/009-02).The target population consisted of patients of both genders, over 18 years old, coinfected with TB and HIV and followed up at IPEC. Included in the study were patients with normal chest X-rays who did not mention BCG re-vaccination and had a positive purified protein derivative (PPD)-tuberculin skin test (induration ≥ 5 mm in diameter) performed by a trained professional. The patients agreed to participate in the study and signed a free informed consent form. This cutoff point was estab...

Factors associated with treatment for latent tuberculosis in persons living with HIV/AIDS

“…These results, along with those of the present study point to the need for new strategies in order to raise awareness among health professionals working in specialized services for HIV/AIDS for the preventive treatment of tuberculosis. The incidence rate of TB in our cohort was similar to rates reported in other studies conducted in Brazil (0.3/100 person-years; 2.3/100 person-years) and Spain (3.5/100 person-year) 21,23,24 .…”

“…A similar percentage of non-initiation of LTB i treatment was encountered in another Brazilian city, Salvador, located in the same region as the present study, where only 69.7% of patients referred for LTB i therapy, initiated treatment 20 . In the city of Rio de Janeiro, initiation of LTB i treatment was higher (85.2%) amongst those who were referred 21 , perhaps because health teams are better trained in order to address the issue of TB prevention in PLWHA.…”

Prevalence of latent tuberculosis and treatment adherence among patients with chronic kidney disease in Campo Grande, State of Mato Grosso do Sul

“…Treatment adherence in this study reached 97.7%, which was greater than the adherence rates reported in other studies (e.g., 87.7% and 44%) 47,48 .…”

Indicação da prova tuberculínica e infecção latente da tuberculose em HIV-positivos, Município de Blumenau, Estado de Santa Catarina, Brasil, 2004-2009

“…É descrito na literatura que os efeitos colaterais relacionados a essa droga existem e são significativamente maiores do que na população que não faz uso da TARV. 27 No entanto, uma metanálise que incluiu 12 ensaios clínicos randomizados, totalizando 8.578 indivíduos, avaliou o tratamento da ILTB em pacientes HIV+ e demonstrou que somente quando se usam esquemas profiláticos combinados (isoniazida e rifampicina, por exemplo), os efeitos adversos são relevantes, podendo levar à descontinuidade da droga. Já os efeitos adversos desencadeados pela monoterapia com isoniazida são bem tolerados e raramente levam à descontinuidade do tratamento.…”

“…12 Oferecer ao paciente informação e percepção, discutir os reais riscos da ILTB e a importância de manter o esquema terapêutico por seis meses parece ser uma medida relacionada à maior adesão ao tratamento. 27 Entre as limitações encontradas para esta análise, é de importância destacar que os dados que lhe serviram de base foram obtidos de prontuários médicos, os quais, dificilmente padronizados, são passíveis de ausência de informações relevantes. Outro fator que pode ter prejudicado as análises destes autores seria a exclusão dos 311 pacientes, em razão dos critérios adotados.…”