Update on the Treatment of Tuberculosis and Latent Tuberculosis Infection

Blumberg, Henry M.; Leonard, Michael; Jasmer, Robert M.

doi:10.1001/jama.293.22.2776

Cited by 158 publications

(104 citation statements)

References 45 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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“…Los 11 casos de tuberculosis diagnosticados, se presentaron en pacientes con recuentos menores de 500 CD4, lo que es consistente con la inmunosupresión de estos pacientes en la presencia de la infección por VIH; esto sigue indicando la patogenicidad de M. tuberculosis y sustenta la recomendación del beneficio de la profilaxis en presencia de recuentos de CD4 por debajo de este nivel (1,6,18).…”

Section: Discussionunclassified

“…El compromiso extrapulmonar y las presentaciones atípicas de la enfermedad tuberculosa son comunes en formas avanzadas de la infección por VIH, lo que puede dificultar el diagnóstico de la tuberculosis; una vez realizado este diagnóstico, es necesario ajustar la terapia antrirretrovial altamente efectiva, por la toxicidad que puede ocurrir al combinar rifampicina con inhibidores no análogos de la transcriptasa inversa o inhibidores de proteasas; en ocasiones estos ajustes requieren la supervisión de expertos (6). Estudios recientes muestran que, a pesar de la terapia antirretroviral, pueden persistir defectos funcionales de los linfocitos CD4 y, por consiguiente, el riesgo de tuberculosis continúa presente (7).…”

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Efectividad de la profilaxis para enfermedad tuberculosa en pacientes infectados por el virus de la inmunodeficiencia humana, Medellín, 2002-2005

Arbeláez¹,

Arbeláez²,

Posada-Gómez³

et al. 2010

biomedica

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Introducción. La profilaxis para tuberculosis ha sido aceptada mundialmente para prevenir las formas activas de la enfermedad, especialmente, en pacientes positivos para VIH; pero en los países de alta prevalencia es aún controvertida su efectividad y sus indicaciones. Objetivo. Establecer en pacientes positivos para VIH el nivel de efectividad de dos esquemas de profilaxis contra la tuberculosis: con isoniacida durante nueve meses o pirazinamida/ rifampicina durante 60 días, suministrados en forma autoadministrada, independientemente de la respuesta a la prueba de tuberculina. Materiales y métodos. Estudio observacional de cohorte. Se conformaron dos grupos, uno con 131 pacientes, quienes voluntariamente aceptaron recibir uno de los dos esquemas profilácticos, si el de pirazinamida/rifampicina no estaba contraindicado. El grupo control estuvo conformado por 200 pacientes seleccionados retrospectivamente, a partir de los registros de un programa de control de pacientes con VIH/sida. El seguimiento para ambos grupos se realizó durante dos años, mediante revisión de la historia clínica. Resultados. Los grupos no presentaron diferencias estadísticas significativas cuando se compararon sus características clínicas, ni demográficas. Una mayor proporción de pacientes del grupo control tuvieron recuento de CD4<200/ml y carga viral>100.000. En el grupo con profilaxis, 8% manifestó efectos adversos, una persona presentó tuberculosis (0,8%) y en el grupo control 10 (5%) [RR=0,15, IC95% 0,18, p=0,07], la protección de la profilaxis fue del 80%, independiente de CD4, carga viral y terapia antirretroviral recibida. Conclusión. La profilaxis para tuberculosis mostró ser efectiva en pacientes positivos para VIH, independientemente del estado inmune, virológico y el tratamiento antirretroviral recibido.Palabras clave: tuberculosis/terapia, profilaxis antibiótica, VIH, síndrome de inmunodeficiencia adquirida, terapia antirretroviral altamente activa, efectividad, Colombia.

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“…The preferred regimen for the treatment of latent tuberculosis is 9 months of isoniazid-which is also intended to kill intracellular pathogens. 96 Notably, both treatments may involve an immunopathological-style reaction. 97,98 However, isoniazid treatment is aimed at killing only one major pathogen whereas patients with autoimmune disease may be targeting multiple phyla of pathogenic microbes.…”

Section: Potential Severity Of Immunopathologymentioning

confidence: 99%

Immunostimulation in the era of the metagenome

Proal

Albert

Blaney³

et al. 2011

Cell Mol Immunol

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Microbes are increasingly being implicated in autoimmune disease. This calls for a re-evaluation of how these chronic inflammatory illnesses are routinely treated. The standard of care for autoimmune disease remains the use of medications that slow the immune response, while treatments aimed at eradicating microbes seek the exact opposite-stimulation of the innate immune response. Immunostimulation is complicated by a cascade of sequelae, including exacerbated inflammation, which occurs in response to microbial death. Over the past 8 years, we have collaborated with American and international clinical professionals to research a model-based treatment for inflammatory disease. This intervention, designed to stimulate the innate immune response, has required a reevaluation of disease progression and amelioration. Paramount is the inherent conflict between palliation and microbicidal efficacy. Increased microbicidal activity was experienced as immunopathology-a temporary worsening of symptoms. Further studies are needed, but they will require careful planning to manage this immunopathology.

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Update on the Treatment of Tuberculosis and Latent Tuberculosis Infection

Cited by 158 publications

References 45 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

Efectividad de la profilaxis para enfermedad tuberculosa en pacientes infectados por el virus de la inmunodeficiencia humana, Medellín, 2002-2005

Immunostimulation in the era of the metagenome

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