Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial

Badjé, Anani; Moh, Raoul; Gabillard, Delphine; Guéhi, Calixte; Kabran, Mathieu; Ntakpé, Jean-Baptiste; Carrou, Jérôme Le; Kouamé, Gérard Menan; Ouattara, Éric; Messou, Eugène; Anzian, Amani; Minga, Albert; Gnokoro, Joachim; Gouessé, Patrice; Emieme, Arlette; Toni, Thomas-d’Aquin; Cyprien, Rabe; Sidibé, Baba; Nzunetu, Gustave; Dohoun, Lambert; Kamagate, Synali; Amon, Solange; Kouame, Amadou-Barenson; Koua, Aboli; Kouamé, Emmanuel; Daligou, Marcelle; Hawerlander, Denise; Ackoundzé, Simplice; Koule, Serge; Séri, Jonas; Ani, A. Noor; Dembélé, Fassery; Fatoumata, Koné; Oyebi, Mykayila; Mbakop, Nathalie; Makaila, Oyewole; Babatunde, Carolle; Babatunde, Nathaniel; Bleoué, Gisèle; Tchoutedjem, Mireille; Kouadio, Alain-Claude; Sena, Ghislaine; Yededji, Sahinou-Yediga; Karcher, Sophie; Rouzioux, Christine; Kouamé, Abo; Assi, R.F.; Bakayoko, A; Domoua, Serge K.; Deschamps, Nina; Aka, Kakou; N’Dri-Yoman, Thérèse; Salamon, Roger; Journot, Valérie; Ahibo, Hughes; Ouassa, Timothée; Menan, Hervé; Inwoley, André; Danel, Christine; Eholié, Serge; Anglaret, Xavier; Kouame, Gérard-Menan; Abo, Yao; Domoua, Serge-K.; N’dja, B.B; Adou, Blandine; Kanga, Constance; Aoussi, E.; Bissagnené, E.; Ba-Gomis, Olivier; Zike, Yves-Alain; Akakpo, Claude; Sassan-Morokro, Madeleine; Mobio, Max; Doféré, Bamba; Mesmin, Koman; Attia, Alain; Mahassadi, Alassane; Horo, Apollinaire; Oussou, A; Chaix, Marie‐Laure; Peytavin, Gilles; Koné, Mariatou; N'Guessan, Kouamé; Fassassi, Raïmi; Niangoran, Serge; Loû, Annabel Desgrées du; Dray‐Spira, Rosemary; Jean, Kévin; Konan, Romuald; Bohoussou, Franck; Yao-Yapi, Cyril; N'guessan-Koffi, Larissa; Bertine, Siloue; Cissé, Adoulaye; Aboua, Adrienne; Konan, Sylvie; Kouamé, Antoine; Nchot, C.; Amani, Elvis; Clouet, Gwenaëlle; Debono, Bruno; Chêne, Geneviève; Dosso, Mireille; Girard, Pierre‐Marie; Jarlier, Vincent; Masumbuko, Jean-Marie; Perronne, Christian; Sow, P. G.; Eholié, S.

doi:10.1016/s2214-109x(17)30372-8

Cited by 135 publications

(107 citation statements)

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“…Global aspirations for an AIDS‐free generation are inspired by data showing that antiretroviral therapy (ART)‐mediated HIV viral suppression reduces HIV transmission risk by 96% , and recent studies provide strong evidence that undetectable = untransmissible (U = U) . Moreover, two randomized controlled trials demonstrated wide‐ranging health benefits of immediate versus delayed ART, even at relatively high CD4 counts . These findings have led to World Health Organization (WHO) treatment guidelines to initiate ART for all people living with HIV (PLWH) regardless of CD4 count .…”

Section: Introductionmentioning

confidence: 99%

ART adherence and viral suppression are high among most non‐pregnant individuals with early‐stage, asymptomatic HIV infection: an observational study from Uganda and South Africa

et al. 2019

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IntroductionThe success of universal antiretroviral therapy (ART) access and aspirations for an AIDS‐free generation depend on high adherence in individuals initiating ART during early‐stage HIV infection; however, adherence may be difficult in the absence of illness and associated support.MethodsFrom March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non‐pregnant women with early‐stage HIV infection (CD4 > 350 cells/μL), pregnant women with early‐stage HIV infection and men and non‐pregnant women with late‐stage HIV infection (CD4 < 200 cells/μL). Socio‐behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically.ResultsAdherence data were available for 869 participants: 322 (37%) early/non‐pregnant, 199 (23%) early/pregnant and 348 (40%) late/non‐pregnant participants. In Uganda, median adherence was 89% (interquartile range 74 to 96) and viral suppression was 90% at 12 months; neither differed among groups (p > 0.72). In South Africa, median adherence was higher in early/non‐pregnant versus early/pregnant or late/non‐pregnant participants (76%, 37%, 52%; p < 0.001), with similar trends in viral suppression (86%, 51%, 79%; p < 0.001). Among early/non‐pregnant individuals in Uganda, adherence was higher with increasing age and lower with structural barriers; whereas in South Africa, adherence was higher with regular income, higher perceived stigma and use of other medications, but lower with maladaptive coping and cigarette smoking.DiscussionART adherence among non‐pregnant individuals with early‐stage infection is as high or higher than with late‐stage initiation, supporting universal access to ART. Challenges remain for some pregnant women and individuals with late‐stage infection in South Africa and highlight the need for differentiated care delivery.

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Section: Introductionmentioning

confidence: 99%

ART adherence and viral suppression are high among most non‐pregnant individuals with early‐stage, asymptomatic HIV infection: an observational study from Uganda and South Africa

et al. 2019

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“…Second, IPT used continuously with ART generally gives coinfected adults additional protection from TB, augmenting that provided by ART alone (9)(10)(11)15). In the 12 countries investigated here, the coverage of IPT among PLHIV over the period 2003-16 was generally low (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…To reduce the incidence of TB in populations with high rates of M. tuberculosis and HIV coinfection, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommend primarily drug treatments to prevent TB disease (isoniazid preventive therapy, IPT, acting on M. tuberculosis infection, and antiretroviral therapy, ART, acting on HIV infection) and to prevent the further transmission of infection from HIV-positive and HIV-negative patients with TB disease (combinations of TB drugs) (4,5). The efficacy of these treatments has been demonstrated in experimental and observational studies (6)(7)(8)(9)(10)(11) and they have the potential markedly to reduce incidence nationally if high rates of coverage can be achieved in target populations (1,2,(12)(13)(14).…”

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confidence: 99%

Antiretroviral therapy is a major cause of tuberculosis decline in southern and eastern Africa

2018

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SignificanceTuberculosis (TB) is still the leading cause of death from a single infectious agent. To cut the TB incidence rate by 80% between 2015 and 2030, in line with the WHO End TB Strategy, demands a five-fold increase in the rate of decline worldwide, from 2% to 10%/year. We find that the reduction in TB incidence rate in 12 African countries, at up to 8%/year, is due mainly to the expanded provision of antiretroviral therapy (ART) to people living with HIV, rather than to improvements in the treatment of TB infection and disease. ART should remain central to TB control where rates of TB-HIV coinfection are high, but new efforts are needed to maximize the direct benefits of treating TB infection and disease. Abstract The incidence of tuberculosis (TB) in southern and eastern Africa was driven sharply upwards during 1980s and 1990s by coinfection with Mycobacterium tuberculosis and the human immunodeficiency virus (HIV). Although drug treatments for TB infection (isoniazid preventive therapy) and disease (combinations of TB drugs) can reduce TB incidence if implemented effectively, we find that antiretroviral therapy (ART) given to people with HIV infection was strongly and systematically associated with the accelerated decline of TB in 12 of the worst affected African countries between 2003 and 2016.Inferring that ART was a significant cause of TB decline, ART prevented approximately 1.88 ± 0.23 million HIV-positive TB cases, or 15.7 ± 1.9 percent of the total number expected. There is no evidence that drug treatment of TB infection (IPT) or disease (combination chemotherapy) played more than a minor role in accelerating TB decline after 2003. In these 12 countries, over the period 2003-16, ART made a major contribution towards achieving international targets for the reduction of TB incidence.

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“…Substantial improvements in TPT initiation in other populations, including children aged <5 years who are household contacts of persons with TB, are necessary to reach the UNHLM-TB targets. Although daily isoniazid has been the primary TPT regimen globally, an alternative regimen of a 12-dose, once-weekly combination of isoniazid and rifapentine has been demonstrated to have similar efficacy with lower toxicity (4) and is anticipated to be increasingly used as a TPT regimen.…”

Section: Discussionmentioning

confidence: 99%

“…TPT (the most common global regimen consists of daily isoniazid for ≥6 months) has been demonstrated to prevent TB disease among persons who might be infected with TB and are at risk for TB disease (4). Current WHO recommendations advise providing a course of TPT to all persons living with HIV and to all household contacts of persons with bacteriologically confirmed pulmonary TB disease (5).…”

Section: Global Epidemiology Of Tuberculosis and Progress Toward Meetmentioning

confidence: 99%

Global Epidemiology of Tuberculosis and Progress Toward Meeting Global Targets — Worldwide, 2018

MacNeil¹,

Glaziou²,

Sismanidis³

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

150

109

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Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial

Abstract: National Research Agency on AIDS and Viral Hepatitis (ANRS).

Cited by 135 publications

References 32 publications

ART adherence and viral suppression are high among most non‐pregnant individuals with early‐stage, asymptomatic HIV infection: an observational study from Uganda and South Africa

ART adherence and viral suppression are high among most non‐pregnant individuals with early‐stage, asymptomatic HIV infection: an observational study from Uganda and South Africa

Antiretroviral therapy is a major cause of tuberculosis decline in southern and eastern Africa

Global Epidemiology of Tuberculosis and Progress Toward Meeting Global Targets — Worldwide, 2018

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