The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil

Golub, Jonathan E.; Saraceni, Valéria; Cavalcante, Solange; Pacheco, Antônio Guilherme; Moulton, Lawrence H.; King, Bonnie S; Efron, Anne; Moore, Richard D.; Chaisson, Richard E.; Durovni, Betina

doi:10.1097/qad.0b013e328216f441

Cited by 271 publications

(251 citation statements)

References 30 publications

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“…However, it is likely that the risk for TB continues to fall for up to 5 y after the start of ART (21), such that the present model may underestimate the impact of ART on TB. We have not included the impact of isoniazid preventive therapy (IPT) on the risk for developing TB in HIV-positive people, which may give a further reduction of about 50% (15,22). Because HIV-related TB has relatively little impact on the risk for TB in HIV-negative people, a good TB control program should be able to reduce the incidence of TB in HIV-negative people, even in the presence of a severe epidemic of HIV.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence rate ratio for TB among people on and off ART, IRR TB ART , has been measured in several studies (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), giving an average value of 0.39 but ranging from 0.2 to 0.75 (SI Appendix, section 4). We assume that the duration of TB disease bears the same relationship to the incidence as it does for people not on ART (SI Appendix, section 4).…”

Section: Methodsmentioning

confidence: 99%

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Antiretroviral therapy for tuberculosis control in nine African countries

Williams

Granich

Cock

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

118

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HIV has increased the incidence of tuberculosis (TB) by up to sevenfold in African countries, but antiretroviral therapy (ART) reduces the incidence of AIDS-related TB. We use a mathematical model to investigate the short-term and long-term impacts of ART on the incidence of TB, assuming that people are tested for HIV once a year, on average, and start ART at a fixed time after HIV seroconversion or at a fixed CD4 + cell count. We fit the model to trend data on HIV prevalence and TB incidence in nine countries in sub-Saharan Africa. If HIV-positive people start ART within 5 y of seroconversion, the incidence of AIDS-related TB in 2015 will be reduced by 48% (range: 37-55%). Long-term reductions depend sensitively on the delay to starting ART. If treatment is started 5, 2, or 1 y after HIV seroconversion, or as soon as people test positive, the incidence in 2050 will be reduced by 66% (range: 57-80%), 95% (range: 93-96%), 97.7% (range: 96.9-98.2%) and 98.4% (range: 97.8-98.9%), respectively. In the countries considered here, early ART could avert 0.71 ± 0.36 [95% confidence interval (CI)] million of 3.4 million cases of TB between 2010 and 2015 and 5.8 ± 2.9 (95% CI) million of 15 million cases between 2015 and 2050. As more countries provide ART at higher CD4 + cell counts, the impact on TB should be investigated to test the predictions of this model.Africa | HIV | test-and-treat

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Antiretroviral therapy for tuberculosis control in nine African countries

Williams

Granich

Cock

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

118

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“…Studies from Brazil 81 and South Africa 82 suggest that sequential or concurrent use of ART and isoniazid preventive therapy could result in a synergistic decline in risk of active tuberculosis, and thus ART clinics are very suitable places in which to start implementation of the 3Is. WHO's advice for ART programmes to gradually phase out stavudine, 36 most probably in favour of tenofovir, will reduce the risk of additive peripheral neuropathy induced by isoniazid.…”

Section: Personal Protection • Use Particulate Respiratorsmentioning

confidence: 99%

The HIV-associated tuberculosis epidemic—when will we act?

et al. 2010

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Journal LancetRights Reproduced on this site with permission of Elsevier Ltd. Please see [url] Tuberculosis 3The HIV-associated tuberculosis epidemic-when will we act? Anthony D Harries, Rony Zachariah, Elizabeth L Corbett, Stephen D Lawn, Ezio T Santos-Filho, Rhehab Chimzizi, Mark Harrington, Dermot Maher, Brian G Williams, Kevin M De Cock Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in aff ected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensifi ed tuberculosis case fi nding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be eff ective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.

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“…TB is currently considered to be the most important opportunistic infection among HIV-1-infected subjects in Brazil 1 and is responsible for a substantial proportion of morbidity and mortality among HIV-infected patients, with approximately 70,000 new cases reported annually 3,4,5,13 . São Paulo State reported 1/3 of Brazilian cases of TB/HIV infection in 2011 1 .…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis among HIV-1-infected subjects in a tertiary out-patient service in São Paulo city, Brazil

Casseb

Fonseca

Medeiros

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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SUMMARYTB is currently considered to be the most important infectious disease among HIV-1-infected subjects in developing countries, such as Brazil. A retrospective analysis of TB cases was performed, occurring from January 1995 to December 2010 in our cohort of 599 HIV positive patients. The primary outcome was the occurrence of active TB. Forty-one TB cases were diagnosed over this period of 16 years, among 599 HIV positive patients in an open cohort setting in the city of Sao Paulo, Brazil. All-time lowest mean CD4 T cell count at the time of TB diagnosis was 146 and 186 cells/mm 3 , respectively. The mean HIV viral load was 5.19 log 10 copies/mL, and 59% of the patients were on HAART. TB incidence was 1.47 per 100 person-years, for a total follow-up time of 2775 person-years. The probability of surviving up to 10 years after diagnosis was 75% for TB patients as opposed to 96% for patients with other, non-TB opportunistic diseases (p = 0.03). TB can be considered a public health problem among people living with HIV in Brazil despite of the widespread use of antiretrovirals for the treatment of HIV infection/AIDS.

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The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil

Cited by 271 publications

References 30 publications

Antiretroviral therapy for tuberculosis control in nine African countries

Antiretroviral therapy for tuberculosis control in nine African countries

The HIV-associated tuberculosis epidemic—when will we act?

Tuberculosis among HIV-1-infected subjects in a tertiary out-patient service in São Paulo city, Brazil

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