Churchyard GJ, Fielding KL, Charalambous S, Day JH, Mantsoe I, Corbett EL, Hayes RJ, Samb B, Grant AD; International Conference on AIDS.

Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. ThPeB7275.

Aurum Health Research Unit, Welkom, South Africa

BACKGROUND: HIV infection is a major risk factor for recurrence of tuberculosis (TB) in countries with high TB incidence. Reinfection is likely to be an important cause of recurrence among HIV-infected individuals. Existing international guidelines make no recommendations for secondary preventive therapy (PT). We compared TB incidence rates among HIV-infected gold miners working in South Africa with a history of previous TB who had or had not received IPT. METHODS: Participants receiving IPT were derived from a cohort of men in WHO stage 3/4 receiving isoniazid and cotrimoxazole indefinitely as part of an earlier trial. The control cohort comprised men attending a routine HIV clinic who did not receive IPT because of a history of previous TB, an exclusion criterion according to current guidelines. RESULTS: 362 men who received IPT were compared to 241 who did not. The median age (40, IQR 35- 45 and 41, IQR 36-46, respectively) and baseline CD4 count (271, IQR 158-402 and 276, IQR 152-440, respectively) were similar in the two groups. TB incidence was reduced by 54% among men receiving IPT compared to those who did not (incidence rates 8.9 and 19.2/100 pys respectively, unadjusted incidence rate ratio (IRR) 0.46; 95% CI 0.3-0.8). Reduction in TB incidence remained significant after adjusting for CD4 count, age and WHO stage. Men who had more than one previous episode of TB, compared to those with only one previous episode, had no significant reduction in TB incidence (IRR 1.7; 95%CI 0.4-6.4 and IRR 0.4; 95%CI 0.2-0.7, respectively). Discussion: HIV-infected individuals living in communities with a high incidence of TB should be offered secondary IPT. The usefulness of secondary PT in patients with more than one previous episode of TB may be limited by increasing antituberculosis drug resistance. IPT may be most effectively targeted to those individuals with more advanced HIV disease.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS Vaccines
• Acquired Immunodeficiency Syndrome
• African Continental Ancestry Group
• Antitubercular Agents
• CD4 Lymphocyte Count
• HIV
• HIV Infections
• HIV Seronegativity
• HIV Seropositivity
• Humans
• Incidence
• Isoniazid
• Male
• Mining
• Risk Factors
• South Africa
• Tuberculosis
• immunology
• prevention & control

Other ID:

• GWAIDS0017422

UI: 102254920

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