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Isoniazid prophylaxis not linked with TB disease-free survival in pediatric patients with HIV
Madhi S. N Engl J Med. 2011;365:21-31.
Nardell E. N Engl J Med. 2011;365:79-81.
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Despite access to antiretroviral therapy and isoniazid prophylaxis, the burden of tuberculosis remained high among HIV-infected children in South Africa, and survival rates were relatively unaffected, according to a study published online this week.
Shabir A. Madhi, MD, PhD, of the University of the Witwatersrand in Johannesburg, South Africa, and colleagues randomly assigned 548 children with HIV and 804 infants who did not have the virus to isoniazid prophylaxis or a placebo for 96 weeks.
Nearly 99% of the children with HIV had access to ART and isoniazid prophylaxis, but there was no differences in the subsequent incident of TB or death, which occurred in “52 children in the isoniazid group and 53 in the placebo group (P=.93).”
The researchers reported similar trends among children who did not have HIV, with like rates of TB infection, TB disease or death between the isoniazid group (39 children) and the placebo group (45 children; P=.44).
The researchers reported that TB rates were 121 cases per 1,000 child-years in the group of children with HIV vs. 41 per 1,000 child-years in the group of children who did not have HIV.
Madhi and colleagues said their study findings may be limited because increased access to ART may have affected the epidemiology of TB in their study cohort, and increased research is needed into the epidemiology of TB.
“These findings underscore the need to explore alternative options for the prevention and management of TB in HIV-exposed children,” they said.
In an accompanying editorial, Edward Nardell, MD, of the division of global health equity at Brigham and Women’s Hospital, and Gavin Churchyard, MD, of Harvard Medical School, called for better diagnosis and control of TB to boost survival rates.
“The risk of TB in young children … points to the need for better control of transmission in the community and in congregate settings, such as clinics, hospitals and prisons,” they wrote. “This can best be achieved by intensified case finding, rapid diagnosis and prompt institution of effective therapy — fully supervised and based on rapid drug-susceptibility testing.”
Disclosure: The study was funded by the NIH and Secure the Future, which is sponsored by Bristol-Myers Squibb.
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