Effect of secondary preventive therapy on recurrence of tuberculosis in HIV-infected individuals: a systematic review

Abstract

Human immunodeficiency virus (HIV)-infected individuals successfully treated for tuberculosis (TB) remain at risk of recurrence of the disease, especially in high TB incidence settings. We performed a systematic review, investigating whether secondary preventive therapy (sPT) with anti-TB drugs (preventive therapy in former TB patients with treatment success) is an effective strategy to prevent recurrence of TB in this patient group. We searched the databases PubMed, Cochrane Library, EMBASE, Web of Science and Google Scholar using the keywords HIV-infections, HIV, human immunodeficiency virus, AIDS, isoniazid, isoniazid preventive therapy (IPT), tuberculosis, TB, recurrence and recurrent disease, resulting in 253 potential publications. We identified eight publications for full text assessment, after which four articles qualified for inclusion in this systematic review. The quality of the included articles was rated using the GRADE system. All but one study were rated as having a high quality. In all included studies, sPT significantly decreased the incidence of recurrent TB in HIV-infected individuals to a substantial degree in comparison to non-treatment or placebo. Relative reductions varied from 55.0% to 82.1%. These data showed that the use of sPT to prevent recurrent TB in HIV-infected individuals was highly beneficial. These findings need to be confirmed in prospective studies with an adequate assessment of the effect of antiretroviral therapy (ART) and the occurrence of drug resistance.

Insights into Recurrent Tuberculosis: Relapse Versus Reinfection and Related Risk Factors

“…A potential approach to prevent recurrent TB is secondary preventative therapy (sPT), by continuing the use of anti-TB therapy following completion of treatment for TB. sPT aims to reduce the incidence of recurrent TB in TB patients who have completed treatment for their most recent episode of TB [100]. The World Health Organization (WHO) recommends the use of isoniazid preventative therapy (IPT) in patients with HIV infection.…”

“…Relative reductions varied from 55.0 to 82.1%. However, only one of the four studies reported a significant effect on overall survival [100]. Perriens et al described the use of isoniazid (INH) and rifampicin (RIF) twice weekly for an additional 6 months in comparison to a placebo.…”

Historical review of studies on the effect of treating latent tuberculosis

“…In high burden populations a number of trials among HIV infected persons have shown the same pattern of marked reduction in rates of active TB among those receiving TPT, as reviewed extensively elsewhere (Bruins and van Leth, 2017;Akolo et al, 2010). Yet, TPT among PLHIV is virtually the only tool currently implemented in high burden populations, with variable success and not rolled out everywhere.…”

Quality of TB care among people living with HIV: Gaps and solutions

“…The WHO recommends treatment of latent TB infection (LTBI) for high risk populations that have higher rates of progression from LTBI to active TB disease [37], especially HIV infected patients who are at 19–21 [38] times higher risk of contracting TB [38,39]. The evidence that TPT is effective in preventing TB and reducing mortality among PLWH is compelling [[40], [41], [42]] with the recent TEMPRANO study demonstrating a 37% reduction in mortality at 6 years among PLWH receiving 6 months of TPT [43].…”