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Free Content Anti-tuberculosis treatment outcomes in HIV-infected adults exposed to isoniazid preventive therapy in Botswana

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Abstract:

SETTING: Eight public health clinics in Gaborone and Francistown, Botswana.

OBJECTIVES: To describe the characteristics and outcomes of incident tuberculosis (TB) cases in human immunodeficiency virus (HIV) infected adults exposed to isoniazid preventive therapy (IPT) with access to antiretroviral and anti-tuberculosis treatment.

DESIGN: In 1995 HIV-infected adults, TB disease was excluded before commencing IPT. During and after receipt of 6 or 36 months of IPT, symptomatic participants were evaluated using chest radiographs, sputum microscopy, cultures and drug susceptibility testing (DST). Incident TB cases received ≥6 months of anti-tuberculosis treatment.

RESULTS: Seventy-five incident TB cases were identified among 619 symptomatic participants. The median duration of IPT in these cases was 6 months (range 1–35), and the median time to initiation of anti-tuberculosis treatment was 12 months after IPT cessation. Antiretroviral therapy (ART) was initiated before anti-tuberculosis treatment in 37 cases. Culture was positive in 43/58 (74%) TB cultures. DST was available for 38 cases, of which six (16%) were resistant to isoniazid (INH); 67/75 (89%) cases, including four with INH-monoresistant TB, completed anti-tuberculosis treatment or were cured.

CONCLUSIONS: With prompt initiation of anti-tuberculosis treatment and access to ART, excellent outcomes were achieved in a public health setting in HIV-infected adults who developed TB disease.

Keywords: HIV infection; antiretroviral therapy; cohort study; tuberculosis; tuberculosis drug resistance

Document Type: Research Article

DOI: https://doi.org/10.5588/ijtld.12.0314

Affiliations: 1: Centers for Disease Control and Prevention Botswana, Gaborone and Francistown, Botswana 2: Botswana Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana 3: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: University of Stellenbosch, Cape Town, South Africa 5: Division of Infectious Diseases, University Hospitals Case Medical Center, Cleveland, Ohio, USA 6: Centers for Disease Control and Prevention (CDC) Botswana, Gaborone and Francistown, Botswana; and Division of Tuberculosis Elimination, CDC, Atlanta, Georgia, USA

Publication date: 2013-02-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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