Isoniazid Intervention Reduces Tuberculosis, Death in HIV Patients

Scaling up preventative isoniazid therapy can curb tuberculosis development and related death in patients infected with HIV, according to research published online Aug. 16 in Lancet Infectious Diseases.

Scaling up preventative isoniazid therapy can curb tuberculosis development and related death in patients infected with HIV, according to research published online Aug. 16 in Lancet Infectious Diseases.

For their four-year “Effect of Improved Tuberculosis Screening and Isoniazid Preventive Therapy on Incidence of Tuberculosis and Death in Patients with HIV” study funded by the Bill & Melinda Gates Foundation and the National Institutes of Health, a team of researchers and experts from Maryland and Brazil offered 12,816 HIV-infected patients from 29 clinics in Rio de Janeiro a daily dose of 300 milligrams of isoniazid, which is marketed as Niazid, Laniazid, and Nydrazid for the treatment of tuberculosis.

After six months of isoniazid intervention, the researchers found that the use of the preventative antibiotic “reduced deaths and new cases of active tuberculosis by 31 percent, while new cases of tuberculosis alone declined by 13 percent,” senior study investigator and Johns Hopkins Center for Tuberculosis Research founding director Richard Chaisson, MD, noted in a press release. Restricting their analysis to 12,196 HIV-infected participants who received at least one annual checkup, the investigators discovered a 55 percent reduction in the death rate and the number of new tuberculosis cases.

Examining the implications of their findings, the authors concluded that the “scale-up of preventive therapy for HIV-infected patients in settings of moderate tuberculosis incidence is achievable and should be widely implemented in Brazil and elsewhere.”

“Our study results show that routine testing for tuberculosis and preventive isoniazid therapy works well at the community level in people with HIV disease in curbing the spread of tuberculosis and lowering the number who die,” Chaisson said. “People with HIV disease living in all countries with rampant tuberculosis should be asking their physicians if they are good candidates for preventive isoniazid therapy.”

In the press release, study author and Hopkins epidemiologist Jonathan Golub, PhD, MPH, said more research on the antibiotic is necessary to “determine how long lasting isoniazid’s protective effects are and whether the single course of treatment used in the latest study is sufficient, or if repeat or lifelong antibiotic therapy is needed to suppress tuberculosis.”