Anti-tuberculosis treatment outcomes in HIV-infected adults exposed to isoniazid preventive therapy in 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.
Document Type: Research Article
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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