Strategies for isoniazid preventive therapy in HIV-positive patients who consume alcohol-Reference-Cited by-同舟云学术

Strategies for isoniazid preventive therapy in HIV-positive patients who consume alcohol

Published:2024-07-01 Issue:7 Volume:28 Page:335-342
ISSN:1027-3719
Container-title:The International Journal of Tuberculosis and Lung Disease
language:en
Short-container-title:int j tuberc lung dis

Author:

Savinkina A.¹,Muyindike W.²,Hahn J.A.³,Emenyonu N.I.⁴,Fatch R.⁴,Ngabirano C.⁵,Adong J.⁵,Jacobson K.R.⁶,Linas B.P.⁶

Affiliation:

1. Public Health Modeling Unit, and the, Epidemiology of Microbial Diseases Department, Yale School of Public Health, New Haven, CT, USA;

2. Mbarara Regional Referral Hospital, Mbarara, Mbarara University of Science and Technology, Mbarara, Uganda;

3. Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, and the, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA,

4. Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, and the

5. Mbarara University of Science and Technology, Mbarara, Uganda;

6. Boston University School of Public Health, Boston, MA, Boston University School of Medicine, Boston, MA, Boston Medical Center, Boston, MA, USA

Abstract

<sec><title>BACKGROUND</title>WHO guidance to defer isoniazid preventive therapy (IPT) among those with regular alcohol use because of hepatotoxicity concerns may exclude many people living with HIV (PLWH) at high TB risk in these settings.</sec><sec><title>OBJECTIVE</title>To evaluate hepatotoxicity during TB preventive therapy (TPT) in PLWH who report alcohol use in Uganda over 10 years.</sec><sec><title>METHODS</title>We developed a Markov model of latent TB infection, isoniazid preventive therapy (IPT - a type of TPT), and TB disease using data from the Alcohol Drinkers’ Exposure to Preventive Therapy for TB (ADEPTT) study. We modeled several treatment scenarios, including no IPT, IPT with liver enzyme monitoring (AST/ALT) during treatment, and IPT with pre-screening using the tuberculin skin test (TST).</sec><sec><title>RESULTS</title>The no IPT scenario had 230 TB deaths/100,000 population over 10 years, which is more than that seen in any IPT scenario. IPT, even with no monitoring, was preferred over no IPT when population TB disease incidence was >50 in 100,000.</sec><sec><title>CONCLUSIONS</title>For PLWH who report alcohol use in high TB burden settings, IPT should be offered, ideally with regular AST/ALT monitoring. However, even if regular monitoring is not possible, IPT is still preferable to no IPT in almost every modeled scenario.</sec>

Publisher

International Union Against Tuberculosis and Lung Disease