The impact of isoniazid preventive therapy and antiretroviral therapy on tuberculosis in children infected with HIV in a high tuberculosis incidence setting

Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch 7700, South Africa.
Thorax (Impact Factor: 8.29). 04/2011; 66(6):496-501. DOI: 10.1136/thx.2010.156752
Source: PubMed


Tuberculosis (TB) is a major cause of morbidity and mortality among children infected with HIV. Strategies to prevent TB in children include isoniazid preventive therapy (IPT) and antiretroviral therapy (ART). IPT and ART have been reported to reduce TB incidence in adults but there are few studies in children.
To investigate the combined effect of IPT and ART on TB risk in children infected with HIV.
A cohort analysis was done within a prospective, double-blinded, placebo-controlled trial of isoniazid (INH) compared with placebo in children infected with HIV in Cape Town, South Africa, a high TB incidence setting. In May 2004 the placebo arm was terminated and all children were switched to INH. ART was not widely available at the start of the study, but children were started on ART following the establishment of the national ART program in 2004. Data were analysed using Cox proportional hazard regression.
After adjusting for age, nutritional status and immunodeficiency at enrolment, INH alone, ART alone and INH combined with ART reduced the risk of TB disease by 0.22 (95% CI 0.09 to 0.53), 0.32 (95% CI 0.07 to 1.55) and 0.11 (95% CI 0.04 to 0.32) respectively. INH reduced the risk of TB disease in children on ART by 0.23 (95% CI 0.05 to 1.00).
The finding that IPT may offer additional protection in children on ART has significant public health implications because this offers a possible strategy for reducing TB in children infected with HIV. Widespread use of this strategy will however require screening of children for active TB disease. Trial registration Trial registration-Clinical Trials NCT00330304.

Download full-text


Available from: Carl Lombard, Nov 11, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: HIV-infected children have a high risk of acquiring tuberculosis. The World Health Organization (WHO) has released isoniazid preventive therapy (IPT) recommendations for adults and children living with HIV, based on efficacy studies, mainly in adults. Data from children appear conflicting. IPT guidelines for children were developed in response to WHO guidelines at a local meeting, followed by discussions. IPT should be given to all HIV-infected children after exposure to a source case if treatment for active disease is not required. For children whose mothers' HIV status was known antentally, when tuberculosis has been actively excluded in mothers and at infant follow-up, and when infants have commenced antiretroviral therapy in the first 3 months of life, IPT is not required. Otherwise, all infants and children should be given IPT for 6 months once active tuberculosis has been excluded.
    No preview · Article · Jun 2011 · Southern African Journal of HIV Medicine

  • No preview · Article · Oct 2011 · New England Journal of Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: In recent years, several notable modifications have occurred in the management of TB infection and disease in children. First, we review new data related to infection, including alternative regimens for the treatment of latent TB, management of drug-resistant infection and preventive therapy in the context of HIV infection. Next, we summarize updated WHO guidelines for the treatment of TB in children, explore issues specific to the management of disease in HIV-infected children, and retreatment of TB, and review pediatric recommendations for the management of drug-resistant TB. Finally, we conclude with a discussion of adjunctive therapy and new drugs in development.
    No preview · Article · Dec 2011 · Expert Review of Anti-infective Therapy
Show more