Effectiveness of isoniazid chemoprophylaxis for HIV-infected drug users at high risk for active tuberculosis

Gourevitch, Marc N.; Hartel, Diana; Selwyn, Peter A.; Schoenbaum, Ellie E.; Klein, Robert S.

doi:10.1097/00002030-199910220-00009

Cited by 47 publications

(60 citation statements)

References 15 publications

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“…An increase in liver enzymes has been described as a relatively frequent adverse event of INH treatment (Blumberg et al 2005), which was observed in two patients of the present study who did not have hepatitis B or C. These results mainly show mild, clinically manageable adverse events and the absence of death or any interaction that may objectively impair follow-up parameters of HAART (CD4 and viral load) and are in agreement with the literature regarding the use of INH chemoprophylaxis (Gourevictch et al 1999, de Pinho et al 2001). …”

Section: Discussionsupporting

confidence: 92%

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

Souza

Hökerberg

Pacheco

et al. 2009

Mem. Inst. Oswaldo Cruz

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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...

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Section: Discussionsupporting

confidence: 92%

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

Souza

Hökerberg

Pacheco

et al. 2009

Mem. Inst. Oswaldo Cruz

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“…INH completion in the routine care group was 13.1%, even lower than the 26% found among homeless clients at the same TB clinic by Tulsky et al (2000). Likewise, INH completion rates in the methadone groups were lower than in uncontrolled studies in methadone maintenance clinics that reported completion rates of 80-90% (Gourevitch et al, 1996;Gourevitch et al, 1998;Snyder et al, 1999).…”

Section: Discussioncontrasting

confidence: 55%

“…A commonly used chemoprophylaxis regimen is 6 months of isoniazid (INH), which decreases occurrence of active TB by 60-90% (Ferebee, 1970;Comstock and Woolpert, 1984; Centers for Disease Control and Prevention (CDC), 1990; Pape et al, 1993) and was at the time of this study the preventive therapy recommended by the American Thoracic Society and the Centers for Disease Control and Prevention (Bass et al, 1994). If, however, patients do not complete preventive therapy, they derive less benefit and develop TB at a higher rate (Gourevitch et al, 1998). Chemoprophylaxis completion rates are frequently low; only about half of patients complete the 6-month course (Centers for Disease Control and Prevention (CDC), 1995b).…”

Section: Introductionmentioning

confidence: 99%

“…A randomized trial studying the impact of location of tuberculosis screening showed that chest radiograph completion by drug users was much higher in a methadone clinic than in a nearby medical clinic (86% vs. 23%) (Umbricht-Schneiter et al, 1994). Completion rates for directly observed INH have been as high as 80-90% in methadone programs (O'Connor et al, 1992;Gourevitch et al, 1998;Snyder et al, 1999), regardless of participants' drug use (Gourevitch et al, 1996). This contrasts with other settings, where TB medication adherence among substance users has been lower than among non-users (Combs et al, 1990), even with direct observation (Burman et al, 1997;Pablos-Maendez et al, 1997;Perlman et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

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A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users

Batki

Gruber

Bradley

et al. 2002

Drug and Alcohol Dependence

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“…This is contrary to our findings. Chemoprophylaxis in this high risk group is associated with marked reduction in tuberculosis risk [17,18]. Some authors however do not conform to this view [19].…”

Section: Discussionmentioning

confidence: 98%

Significance of Tuberculin Testing in HIV Infection: An Indian Perspective

Sawhney¹

2006

Medical Journal Armed Forces India

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Effectiveness of isoniazid chemoprophylaxis for HIV-infected drug users at high risk for active tuberculosis

Cited by 47 publications

References 15 publications

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

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

A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users

Significance of Tuberculin Testing in HIV Infection: An Indian Perspective

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