Are the effects of isoniazid preventive therapy and highly active antiretroviral therapy additive in preventing HIV-associated tuberculosis?

摘要

Golub et al. [1] recently reported a retrospective analysis of rates of incident tuberculosis (TB) in a large observational cohort of 2778 patients accessing HIV care in rural and urban South Africa. The TB incidence rate was highest [7.1/100 person-years; 95% confidence interval (CI) = 6.2-8.2] during the period of care when patients did not receive isoniazid preventive therapy (IPT) or highly active antiretroviral therapy (HAART). The rates were lower during person-time that accrued throughout follow-up after initiation of IPT (5.2/100 person-years; 95% CI = 3.4-7.8) and throughout follow-up on HAART alone (4.6/100 person-years, 95% CI = 3.4-6.2). The rate was lower still (1.1/100 person-years 95% CI = 0.2-7.6) during person-time accrued during sequential IPT and HAART (IPT + HAART). The authors concluded that TB risk was significantly reduced by IPT in HAART-treated adults. It was further concluded that 'the dramatic reduction in TB risk' demonstrated in this study together with supportive data from a similarly analysed study from Brazil [2] indicates that widespread use of IPT should be implemented in conjunction with the roll-out of HAART.