{"id":2458,"date":"2007-07-03T22:51:00","date_gmt":"2007-07-03T21:51:00","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=2458"},"modified":"2013-09-20T15:07:01","modified_gmt":"2013-09-20T15:07:01","slug":"long-term-effectiveness-of-isoniazid-prophylaxis-on-tb-incidence-in-a-cohort-of-idus","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/2458","title":{"rendered":"Long-term effectiveness of isoniazid prophylaxis on TB incidence in a cohort of IDUs"},"content":{"rendered":"<p><strong>Jonathan Golub and co-workers from the AIDS Linked to Intravenous Experience (ALIVE), cohort in Baltimore USA assessed long-term effectiveness of an 8-year tuberculin skin testing (TST)\/isoniazid (IPT) programme among a cohort of HIV-positive and HIV-negative IDUs.<\/strong><\/p>\n<p>This cohort includes &gt;2000 IDUs in Baltimore, 35% of whom were HIV-positive at baseline. TST and IPT were offered to all ALIVE participants from 1990 to 1998. TB incidence was measured in 3 periods: \u00a0pre-purified protein derivative (PPD) era (1988-1990), PPD era (1990-1998), and post-PPD era (1998-2004). Incidence rate ratios compared TB incidences among eras.<\/p>\n<p>The investigators found out of a group of 753 HIV-positive participants, 651 (86%) had a TST ; 103 (16%) had a positive result (&gt;5 mm); 65 (60%) started IPT; and 40 (62%) completed 6 months. Of the1264 HIV-negative participants, 1105 (87%) had a TST; 435 (39%) had a positive result (&gt;10 mm); 246 (56%) started IPT; and 133 (54%) completed 6 months. In total, 32% of those with a positive TST completed 6 months of IPT.<\/p>\n<p>In this study 30 TB cases were diagnosed over 28,750 person-years: \u00a0IR = 1.04\/1000 person-years in HIV-negative; IR = 2.66\/1000 person-years among the HIV-positive population. The investigators reported TB incidence in the post-PPD-era for the overall cohort was half that seen in the PPD-era (IRR = 0.44, 95%CI 0.19 to 1.04), but they found no significant difference between eras in the HIV-positive population (2.04 vs 3.14\/1000 person-years; IR = 0.64, 95%CI 0.27 to 1.58).<\/p>\n<p>Both overall and amongst the HIV-positive participants, TB incidence among those who never received IPT was greater than those who started IPT; no cases were detected for those who received 6 months of IPT. Among the HIV-positive participants the investigators found body mass index &lt;21 (RH = 3.1, p &lt;0.01) and CD4 &lt;200 (RH = 9.6, p &lt;0.01) to be most predictive of TB. ART use had no association with risk of TB.<\/p>\n<p>The investigators reported that a significant long-term reduction in TB incidence was observed in a cohort of IDU with a high HIV prevalence after an 8-year strategy of TST\/IPT, but no change was seen in the HIV-positive subset. They noted that IPT was highly effective for those who completed it, but only 32% of TST-positive patients completed. \u0093Broader use of IPT in HIVIDUs could substantially decrease TB incidence\u0094 they wrote.<\/p>\n<p class=\"ref\">Reference:<\/p>\n<p class=\"ref\">Jonathan Golub, J Astemborski, M Ahmed et al. Long-term effectiveness of isoniazid preventive therapy on TB Incidence in a cohort of injection drug users. 14th CROI, 2007. Los Angeles. Abstract 851.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Jonathan Golub and co-workers from the AIDS Linked to Intravenous Experience (ALIVE), cohort in Baltimore USA assessed long-term effectiveness of an 8-year tuberculin skin testing (TST)\/isoniazid (IPT) programme among a cohort of HIV-positive and HIV-negative IDUs. This cohort includes &gt;2000 &hellip;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,37],"tags":[61],"class_list":["post-2458","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-tb-coinfection","tag-croi-2007"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2458","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=2458"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2458\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=2458"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=2458"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=2458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}