This review investigated whether preventive therapy for latent TB could reduce its active prevalence in people with HIV
- Figures and tables can be seen in the attached print-friendly PDF file of the complete article
Khalil H (2011) Treating TB in people with HIV. Nursing Times; 107: 38, early online publication.
How effective is tuberculosis (TB) preventive therapy in reducing the risk of active TB and death in people with HIV?
The development of antiviral treatments has made HIV infection a long-term and manageable disease. However, the success of HIV treatment can easily be set back by the high prevalence of TB in these patients. Preventing TB is therefore one of the most important measures in reducing early mortality and morbidity associated with HIV infections.
Nurses play a significant role in caring for these patients in various healthcare settings. It is crucial that nurses are aware of the effectiveness of various therapies to reduce TB in HIV-infected patients. A systematic review was undertaken to investigate this.
This summary is based on a Cochrane systematic review of 12 randomised controlled trials, which included a total of 8,578 participants. In all trials, participants were randomly allocated to TB preventive therapy or placebo, or to alternative TB preventive therapy regimens.
Preventive therapy was defined as: “TB chemotherapy given to people at high risk of developing TB to prevent active disease.” The optimal duration of treatment and the best treatment regimen for people with HIV were not considered in the review.
The primary outcomes measured included: active TB (based on microbiological diagnosis, histological diagnosis, or as a defined clinical syndrome); interval from initiation of preventive therapy to active TB; and survival (incidence of death and interval to death).
Study sizes ranged from 98 to 2,018
participants, while participants were 13 years or older with a mean age of 33 years. Across all the trials, 47% were women, with a range of 20% to 69% in individual trials.
The study participants had active TB, diagnosed by culture or other methods of diagnosis as defined by the various authors. The mean duration of follow-up ranged between one and three years.
Summary of key evidence
A meta-analysis of 10 trials involving 5,762 patients demonstrated that preventive therapy (anti-TB drug) versus a placebo reduced the risk of active TB by 32%.
A meta-analysis of four trials with 2,378 participants found that preventive therapy reduced the risk of active TB by 62% in individuals with a positive tuberculin skin test.
There was no evidence of effect for individuals with a negative tuberculin test (seven studies; 2,822 participants).
A meta-analysis of all drug regimens, regardless of type, frequency or duration of treatment, reduced the incidence of active TB compared with a placebo.
Results from nine pooled studies (5,762 participants) indicated there was no statistical difference in all-cause mortality between preventive therapy and placebo.
Adverse drug reactions considered to be serious enough to discontinue treatment were reported in six trials and compared with placebo; intervention groups had significantly higher adverse effects.
People having multi-drug combination therapies were more likely to discontinue treatment because of adverse effects than those taking a single drug.
The evidence suggests that treatment of latent tuberculosis infection significantly reduces the risk of active TB in HIV positive individuals, particularly those with a positive tuberculin skin test.
The efficacy was similar for all drug regimens irrespective of drug type, frequency, or the duration of treatment.
Monotherapy and short-course multi-therapy were found to be significantly less likely to be discsontinued because of adverse side effects.
The full review report, including references, can be accessed at tinyurl.com/coch-tb-hiv
Hanan Khalil is senior lecturer/pharmacist academic, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, and a member of the Cochrane Nursing Care Field
Akolo C et al (2010) Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database of Systematic Reviews; Issue 1, Art No: CD000171. DOI: 10.1002/14651858.CD000171.pub3.