Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort
Identifieur interne : 001076 ( Pmc/Corpus ); précédent : 001075; suivant : 001077Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort
Auteurs : Jonathan E. Golub ; Paul Pronyk ; Lerato Mohapi ; Nkeko Thsabangu ; Mosa Moshabela ; Helen Struthers ; Glenda E. Gray ; James A. Mcintyre ; Richard E. Chaisson ; Neil A. MartinsonSource :
- AIDS (London, England) [ 0269-9370 ] ; 2009.
Abstract
The World Health Organization recommends isoniazid preventive therapy (IPT) for preventing tuberculosis in HIV-infected adults, although few countries have instituted this policy. Both IPT and highly active antiretroviral therapy (HAART) used separately result in reductions in tuberculosis risk. There is less information on the combined effect of IPT and HAART. We assessed the effect of IPT, HAART or both IPT and HAART on tuberculosis incidence in HIV-infected adults in South Africa.
Two clinical cohorts of HIV-infected patients were studied. Primary exposures were receipt of IPT and/or HAART and the primary outcome was incident tuberculosis. Crude incident rates and incident rate ratios were calculated and Cox proportional hazards models investigated associations with tuberculosis risk.
Among 2778 HIV-infected patients followed for 4287 person-years, 267 incident tuberculosis cases were diagnosed [incidence rate ratio (IRR) = 6.2/100 person-years; 95% CI 5.5–7.0]. For person-time without IPT or HAART, the IRR was 7.1/100 person-years (95% CI 6.2–8.2); for person-time receiving HAART but without IPT, the IRR was 4.6/100 person-years (95% CI 3.4–6.2); for person-time after IPT but prior to HAART, the IRR was 5.2/100 person-years (95% CI 3.4–7.8); during follow-up in patients treated with HAART after receiving IPT the IRR was 1.1/100 person-years (95% CI 0.02–7.6). Compared to treatment-naive patients, HAART-only patients had a 64% decreased hazard for tuberculosis [adjusted hazard ratio (aHR) = 0.36; 95% CI 0.25–0.51], and patients receiving HAART after IPT had a 89% reduced hazard (aHR = 0.11; 95% CI 0.02–0.78).
Tuberculosis risk is significantly reduced by IPT in HAART-treated adults in a high-incidence operational setting in South Africa. IPT is an inexpensive and cost-effective strategy and our data strengthen calls for the implementation of IPT in conjunction with the roll-out of HAART.
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DOI: 10.1097/QAD.0b013e328327964f
PubMed: 19525621
PubMed Central: 3063949
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort</title><author><name sortKey="Golub, Jonathan E" sort="Golub, Jonathan E" uniqKey="Golub J" first="Jonathan E." last="Golub">Jonathan E. Golub</name><affiliation><nlm:aff id="A1"> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Pronyk, Paul" sort="Pronyk, Paul" uniqKey="Pronyk P" first="Paul" last="Pronyk">Paul Pronyk</name><affiliation><nlm:aff id="A3"> London School of Hygiene and Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A4"> School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Mohapi, Lerato" sort="Mohapi, Lerato" uniqKey="Mohapi L" first="Lerato" last="Mohapi">Lerato Mohapi</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Thsabangu, Nkeko" sort="Thsabangu, Nkeko" uniqKey="Thsabangu N" first="Nkeko" last="Thsabangu">Nkeko Thsabangu</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Moshabela, Mosa" sort="Moshabela, Mosa" uniqKey="Moshabela M" first="Mosa" last="Moshabela">Mosa Moshabela</name><affiliation><nlm:aff id="A4"> School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Struthers, Helen" sort="Struthers, Helen" uniqKey="Struthers H" first="Helen" last="Struthers">Helen Struthers</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Gray, Glenda E" sort="Gray, Glenda E" uniqKey="Gray G" first="Glenda E." last="Gray">Glenda E. Gray</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Mcintyre, James A" sort="Mcintyre, James A" uniqKey="Mcintyre J" first="James A." last="Mcintyre">James A. Mcintyre</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Chaisson, Richard E" sort="Chaisson, Richard E" uniqKey="Chaisson R" first="Richard E." last="Chaisson">Richard E. Chaisson</name><affiliation><nlm:aff id="A1"> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Martinson, Neil A" sort="Martinson, Neil A" uniqKey="Martinson N" first="Neil A." last="Martinson">Neil A. Martinson</name><affiliation><nlm:aff id="A1"> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19525621</idno><idno type="pmc">3063949</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063949</idno><idno type="RBID">PMC:3063949</idno><idno type="doi">10.1097/QAD.0b013e328327964f</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">001076</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001076</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort</title><author><name sortKey="Golub, Jonathan E" sort="Golub, Jonathan E" uniqKey="Golub J" first="Jonathan E." last="Golub">Jonathan E. Golub</name><affiliation><nlm:aff id="A1"> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Pronyk, Paul" sort="Pronyk, Paul" uniqKey="Pronyk P" first="Paul" last="Pronyk">Paul Pronyk</name><affiliation><nlm:aff id="A3"> London School of Hygiene and Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A4"> School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Mohapi, Lerato" sort="Mohapi, Lerato" uniqKey="Mohapi L" first="Lerato" last="Mohapi">Lerato Mohapi</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Thsabangu, Nkeko" sort="Thsabangu, Nkeko" uniqKey="Thsabangu N" first="Nkeko" last="Thsabangu">Nkeko Thsabangu</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Moshabela, Mosa" sort="Moshabela, Mosa" uniqKey="Moshabela M" first="Mosa" last="Moshabela">Mosa Moshabela</name><affiliation><nlm:aff id="A4"> School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Struthers, Helen" sort="Struthers, Helen" uniqKey="Struthers H" first="Helen" last="Struthers">Helen Struthers</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Gray, Glenda E" sort="Gray, Glenda E" uniqKey="Gray G" first="Glenda E." last="Gray">Glenda E. Gray</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Mcintyre, James A" sort="Mcintyre, James A" uniqKey="Mcintyre J" first="James A." last="Mcintyre">James A. Mcintyre</name><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author><author><name sortKey="Chaisson, Richard E" sort="Chaisson, Richard E" uniqKey="Chaisson R" first="Richard E." last="Chaisson">Richard E. Chaisson</name><affiliation><nlm:aff id="A1"> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Martinson, Neil A" sort="Martinson, Neil A" uniqKey="Martinson N" first="Neil A." last="Martinson">Neil A. Martinson</name><affiliation><nlm:aff id="A1"> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A5"> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">The World Health Organization recommends isoniazid preventive therapy (IPT) for preventing tuberculosis in HIV-infected adults, although few countries have instituted this policy. Both IPT and highly active antiretroviral therapy (HAART) used separately result in reductions in tuberculosis risk. There is less information on the combined effect of IPT and HAART. We assessed the effect of IPT, HAART or both IPT and HAART on tuberculosis incidence in HIV-infected adults in South Africa.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">Two clinical cohorts of HIV-infected patients were studied. Primary exposures were receipt of IPT and/or HAART and the primary outcome was incident tuberculosis. Crude incident rates and incident rate ratios were calculated and Cox proportional hazards models investigated associations with tuberculosis risk.</p></sec><sec id="S3"><title>Results</title><p id="P3">Among 2778 HIV-infected patients followed for 4287 person-years, 267 incident tuberculosis cases were diagnosed [incidence rate ratio (IRR) = 6.2/100 person-years; 95% CI 5.5–7.0]. For person-time without IPT or HAART, the IRR was 7.1/100 person-years (95% CI 6.2–8.2); for person-time receiving HAART but without IPT, the IRR was 4.6/100 person-years (95% CI 3.4–6.2); for person-time after IPT but prior to HAART, the IRR was 5.2/100 person-years (95% CI 3.4–7.8); during follow-up in patients treated with HAART after receiving IPT the IRR was 1.1/100 person-years (95% CI 0.02–7.6). Compared to treatment-naive patients, HAART-only patients had a 64% decreased hazard for tuberculosis [adjusted hazard ratio (aHR) = 0.36; 95% CI 0.25–0.51], and patients receiving HAART after IPT had a 89% reduced hazard (aHR = 0.11; 95% CI 0.02–0.78).</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Tuberculosis risk is significantly reduced by IPT in HAART-treated adults in a high-incidence operational setting in South Africa. IPT is an inexpensive and cost-effective strategy and our data strengthen calls for the implementation of IPT in conjunction with the roll-out of HAART.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id><journal-id journal-id-type="pubmed-jr-id">1493</journal-id><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-title>AIDS (London, England)</journal-title><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn></journal-meta><article-meta><article-id pub-id-type="pmid">19525621</article-id><article-id pub-id-type="pmc">3063949</article-id><article-id pub-id-type="doi">10.1097/QAD.0b013e328327964f</article-id><article-id pub-id-type="manuscript">NIHMS279588</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Golub</surname><given-names>Jonathan E.</given-names></name><xref rid="A1" ref-type="aff">a</xref><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Pronyk</surname><given-names>Paul</given-names></name><xref rid="A3" ref-type="aff">c</xref><xref rid="A4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Mohapi</surname><given-names>Lerato</given-names></name><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>Thsabangu</surname><given-names>Nkeko</given-names></name><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>Moshabela</surname><given-names>Mosa</given-names></name><xref rid="A4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Struthers</surname><given-names>Helen</given-names></name><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>Gray</surname><given-names>Glenda E.</given-names></name><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>McIntyre</surname><given-names>James A.</given-names></name><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>Chaisson</surname><given-names>Richard E.</given-names></name><xref rid="A1" ref-type="aff">a</xref><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Martinson</surname><given-names>Neil A.</given-names></name><xref rid="A1" ref-type="aff">a</xref><xref rid="A5" ref-type="aff">e</xref></contrib></contrib-group><aff id="A1"><label>a</label> Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA</aff><aff id="A2"><label>b</label> Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA</aff><aff id="A3"><label>c</label> London School of Hygiene and Tropical Medicine, London, UK</aff><aff id="A4"><label>d</label> School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa</aff><aff id="A5"><label>e</label> Perinatal HIV Research Unit, University of the Witwatersrand, Witwatersrand, South Africa</aff><author-notes><corresp id="FN1">Correspondence to Jonathan E. Golub, PhD, MPH, Johns Hopkins University, 1550 Orleans St., 1M.07 Baltimore, MD 21231, USA. Tel: +1 443 287 2969; fax: +1 410 955 0740; <email>jgolub@jhmi.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>11</day><month>3</month><year>2011</year></pub-date><pub-date pub-type="ppub"><day>13</day><month>3</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>25</day><month>3</month><year>2011</year></pub-date><volume>23</volume><issue>5</issue><fpage>631</fpage><lpage>636</lpage><abstract><sec id="S1"><title>Background</title><p id="P1">The World Health Organization recommends isoniazid preventive therapy (IPT) for preventing tuberculosis in HIV-infected adults, although few countries have instituted this policy. Both IPT and highly active antiretroviral therapy (HAART) used separately result in reductions in tuberculosis risk. There is less information on the combined effect of IPT and HAART. We assessed the effect of IPT, HAART or both IPT and HAART on tuberculosis incidence in HIV-infected adults in South Africa.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">Two clinical cohorts of HIV-infected patients were studied. Primary exposures were receipt of IPT and/or HAART and the primary outcome was incident tuberculosis. Crude incident rates and incident rate ratios were calculated and Cox proportional hazards models investigated associations with tuberculosis risk.</p></sec><sec id="S3"><title>Results</title><p id="P3">Among 2778 HIV-infected patients followed for 4287 person-years, 267 incident tuberculosis cases were diagnosed [incidence rate ratio (IRR) = 6.2/100 person-years; 95% CI 5.5–7.0]. For person-time without IPT or HAART, the IRR was 7.1/100 person-years (95% CI 6.2–8.2); for person-time receiving HAART but without IPT, the IRR was 4.6/100 person-years (95% CI 3.4–6.2); for person-time after IPT but prior to HAART, the IRR was 5.2/100 person-years (95% CI 3.4–7.8); during follow-up in patients treated with HAART after receiving IPT the IRR was 1.1/100 person-years (95% CI 0.02–7.6). Compared to treatment-naive patients, HAART-only patients had a 64% decreased hazard for tuberculosis [adjusted hazard ratio (aHR) = 0.36; 95% CI 0.25–0.51], and patients receiving HAART after IPT had a 89% reduced hazard (aHR = 0.11; 95% CI 0.02–0.78).</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Tuberculosis risk is significantly reduced by IPT in HAART-treated adults in a high-incidence operational setting in South Africa. IPT is an inexpensive and cost-effective strategy and our data strengthen calls for the implementation of IPT in conjunction with the roll-out of HAART.</p></sec></abstract><kwd-group><kwd>HAART</kwd><kwd>isoniazid</kwd><kwd>preventive treatment</kwd><kwd>sub-Saharan Africa</kwd><kwd>tuberculosis</kwd></kwd-group><contract-num rid="TW1">U2R TW007373-05
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||AI</contract-num><contract-sponsor id="TW1">Fogarty International Center : FIC</contract-sponsor><contract-sponsor id="AI1">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</contract-sponsor></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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