BACKGROUND: Tuberculosis is a common complication and leading cause of death in HIV infection. Antiretroviral therapy (ART) lowers the risk of tuberculosis, but may not be sufficient to control HIV-related tuberculosis. Isoniazid preventive therapy (IPT) reduces tuberculosis incidence significantly, but is not widely used. METHODS: We analysed tuberculosis incidence in 11 026 HIV-infected patients receiving medical care at 29 public clinics in Rio de Janeiro, Brazil, between 1 September 2003 and 1 September 2005. Data were collected through a retrospective medical record review. We determined rates of tuberculosis in patients who received neither ART nor IPT, only ART, only IPT, or both ART and IPT. RESULTS: The overall tuberculosis incidence was 2.28 cases/100 person-years (PY) [95% confidence interval (CI) 2.06-2.52]. Among patients who received neither ART nor IPT, incidence was 4.01/100 PY. Patients who received ART had an incidence of 1.90/100 PY (95% CI 1.66-2.17) and those treated with IPT had a rate of 1.27/100 PY (95% CI 0.41-2.95). The incidence among patients who received ART and IPT was 0.80/100 PY (95% CI 0.38-1.47). Multivariate Cox proportional hazards modeling revealed a 76% reduction in tuberculosis risk among patients receiving both ART and IPT (adjusted relative hazard 0.24; P < 0.001) after adjusting for age, previous tuberculosis diagnosis, and CD4 cell counts at baseline. CONCLUSION: The use of both IPT and ART in HIV-infected patients is associated with significantly reduced tuberculosis incidence. In conjunction with expanded access to ART, the wider use of IPT in patients with HIV will improve tuberculosis control in high burden areas.
BACKGROUND:Tuberculosis is a common complication and leading cause of death in HIV infection. Antiretroviral therapy (ART) lowers the risk of tuberculosis, but may not be sufficient to control HIV-related tuberculosis. Isoniazid preventive therapy (IPT) reduces tuberculosis incidence significantly, but is not widely used. METHODS: We analysed tuberculosis incidence in 11 026 HIV-infectedpatients receiving medical care at 29 public clinics in Rio de Janeiro, Brazil, between 1 September 2003 and 1 September 2005. Data were collected through a retrospective medical record review. We determined rates of tuberculosis in patients who received neither ART nor IPT, only ART, only IPT, or both ART and IPT. RESULTS: The overall tuberculosis incidence was 2.28 cases/100 person-years (PY) [95% confidence interval (CI) 2.06-2.52]. Among patients who received neither ART nor IPT, incidence was 4.01/100 PY. Patients who received ART had an incidence of 1.90/100 PY (95% CI 1.66-2.17) and those treated with IPT had a rate of 1.27/100 PY (95% CI 0.41-2.95). The incidence among patients who received ART and IPT was 0.80/100 PY (95% CI 0.38-1.47). Multivariate Cox proportional hazards modeling revealed a 76% reduction in tuberculosis risk among patients receiving both ART and IPT (adjusted relative hazard 0.24; P < 0.001) after adjusting for age, previous tuberculosis diagnosis, and CD4 cell counts at baseline. CONCLUSION: The use of both IPT and ART in HIV-infectedpatients is associated with significantly reduced tuberculosis incidence. In conjunction with expanded access to ART, the wider use of IPT in patients with HIV will improve tuberculosis control in high burden areas.
Authors: José L Casado; Santiago Moreno; Jesús Fortún; Antonio Antela; Carmen Quereda; Enrique Navas; Ana Moreno; Fernando Dronda Journal: Clin Infect Dis Date: 2001-12-19 Impact factor: 9.079
Authors: Guilherme Santoro-Lopes; Ana Maria Felix de Pinho; Lee H Harrison; Mauro Schechter Journal: Clin Infect Dis Date: 2002-01-07 Impact factor: 9.079
Authors: Gavin J Churchyard; Katherine Fielding; Salome Charalambous; John H Day; Elizabeth L Corbett; Richard J Hayes; Richard E Chaisson; Kevin M De Cock; Badara Samb; Alison D Grant Journal: AIDS Date: 2003-09-26 Impact factor: 4.177
Authors: Elizabeth L Corbett; Catherine J Watt; Neff Walker; Dermot Maher; Brian G Williams; Mario C Raviglione; Christopher Dye Journal: Arch Intern Med Date: 2003-05-12
Authors: B Mosimaneotsile; E A Talbot; T L Moeti; N M Hone; G Moalosi; H J Moffat; E J Lee; T A Kenyon Journal: Lancet Date: 2003-11-08 Impact factor: 79.321
Authors: Richard E Nettles; Dana Mazo; Karla Alwood; Regina Gachuhi; Gina Maltas; Karen Wendel; Wendy Cronin; Nancy Hooper; William Bishai; Timothy R Sterling Journal: Clin Infect Dis Date: 2004-02-17 Impact factor: 9.079
Authors: Brian G Williams; Reuben Granich; Kevin M De Cock; Philippe Glaziou; Abhishek Sharma; Christopher Dye Journal: Proc Natl Acad Sci U S A Date: 2010-10-25 Impact factor: 11.205
Authors: Salome Charalambous; Alison D Grant; Craig Innes; Christopher J Hoffmann; Rob Dowdeswell; Jan Pienaar; Katherine L Fielding; Gavin J Churchyard Journal: AIDS Date: 2010-11 Impact factor: 4.177
Authors: Betina Durovni; Solange C Cavalcante; Valeria Saraceni; Vitoria Vellozo; Giselle Israel; Bonnie S King; Silvia Cohn; Anne Efron; Antonio G Pacheco; Lawrence H Moulton; Richard E Chaisson; Jonathan E Golub Journal: AIDS Date: 2010-11 Impact factor: 4.177
Authors: April C Pettit; Cathy A Jenkins; Samuel E Stinnette; Peter F Rebeiro; Robert B Blackwell; Stephen P Raffanti; Bryan E Shepherd; Timothy R Sterling Journal: J Acquir Immune Defic Syndr Date: 2011-08-01 Impact factor: 3.731
Authors: S D Lawn; A D Harries; B G Williams; R E Chaisson; E Losina; K M De Cock; R Wood Journal: Int J Tuberc Lung Dis Date: 2011-05 Impact factor: 2.373
Authors: David W Dowdy; Jonathan E Golub; Valeria Saraceni; Lawrence H Moulton; Solange C Cavalcante; Silvia Cohn; Antonio G Pacheco; Richard E Chaisson; Betina Durovni Journal: J Acquir Immune Defic Syndr Date: 2014-08-15 Impact factor: 3.731
Authors: Valeria Saraceni; Silvia Cohn; Solange C Cavalcante; Antonio G F Pacheco; Lawrence H Moulton; Richard E Chaisson; Betina Durovni; Jonathan E Golub Journal: J Acquir Immune Defic Syndr Date: 2014-09-01 Impact factor: 3.731