Gray DM, Zar H, Cotton M

Summary

The impact of tuberculosis preventive therapy on tuberculosis and death in HIV-infected children

Tuberculosis (TB) is a common cause of severe lung disease and death in children infected with HIV, particularly those living in areas of high TB prevalence; thus, preventing the infection and disease in HIV-infected children is potentially an important major public health intervention. Isoniazid, a medication used in the treatment of TB, has been used effectively to prevent TB in HIV-uninfected children exposed to TB. It is unclear, however, what impact TB preventive therapy, such as isoniazid, has on the rate of TB infection or death if given to HIV-infected children with and without exposure to TB; our review aims to assess this impact. We found only one published randomised controlled trial investigating TB preventive therapy in HIV-infected children. The trial showed a marked reduction in TB incidence and death in the group of children who received isoniazid as primary preventive therapy. Few adverse events occurred during the study and none were related to the isoniazid therapy. Currently, there are no long-term follow-up data on the durability of protective effect or possible long-term adverse events. This trial also was unable to assess the impact of isoniazid prophylaxis on children receiving antiretroviral therapy. Further studies are needed to assess whether TB preventive therapy is of benefit in all HIV-infected children, irrespective of antiretroviral treatment, the optimal duration of preventive therapy, or long-term adverse effects.