Posted on October 09, 2017
Source: The Lancet Global Health
Failure to prevent tuberculosis in people with HIV infection has resulted in millions of lives lost over the past decade, say CFAR Principal Investigator Richard Chaisson, MD, and JHUSOM Associate Professor Jonathan Golub, PhD, in a Comment in Lancet Global Health. Despite a recommendation from the World Health Organization (WHO) that all HIV-infected people should receive preventive therapy with an inexpensive antibiotic that has been widely available for more than 60 years, uptake of this policy has been dismal. The results of the TEMPRANO Study, published in the November issue of Lancet Global Health, show that treating adults with HIV infection in Cote D’Ivoire with 6 months of the drug, isoniazid, resulted in a 37% reduction in the risk of death over 5 years of follow up. The impact of the treatment, given to people early in the course of HIV disease, was independent of antiretroviral therapy (ART), but people who receive both isoniazid and ART had an even lower risk of dying.
Drs. Chaisson and Golub, working with colleagues at the Health Department in Rio de Janeiro, Brazil, had previously shown that isoniazid was highly effective in patients with more advanced HIV infection, and that providing isoniazid and ART significantly reduced the risk of both TB and death. The TEMPRANO Study extends these findings even further, showing the impact of isoniazid preventive therapy in earlier stages of HIV infection. But despite the longstanding guideline from the WHO, fewer than 1 million people, out of more than 30 million eligible patients, received the treatment in 2015. Reasons for the poor adoption of the therapy include unwarranted fears of drug resistance, concerns about how long the benefit would last, and the need to prioritize ART.
In their commentary, Chaisson and Golub state that there should be no more excuses for global agencies, national departments of health, clinicians and patient advocacy groups to ignore the importance of TB and the impact of isoniazid. They note that AIDS denialism on the part of former South African President Thabo Mbeki was estimated to have resulted in 330,000 deaths in the early 1990s as use of ART was obstructed and delayed. They argue that similar TB denialism has cost millions of lives since 2008 when the WHO strongly recommended that isoniazid be provided to people with HIV infection. “This shameful figure should motivate the global HIV community to accelerate current feeble efforts to provide tuberculosis preventive therapy to all HIV-infected people living in high-burden settings. If a new ART regimen were shown, like IPT [isoniazid preventive therapy] in TEMPRANO, to reduce mortality by 37%, the demand for immediate access from clinicians, programmes, international agencies, and the advocacy community would be deafening,” they conclude.
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