Effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS – retrospective analysis of data from Almaty, Kazakhstan, 2010–2015
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KIT Royal Tropical Institute, Amsterdam, The Netherlands
University of Economics and Innovation, Lublin, Poland
Magdalena Głowacka   

University of Economics and Innovation, Projektowa 4, 20-209, Lublin, Poland
Ann Agric Environ Med. 2020;27(4):695–701
According to data from the National Centre for Prevention and Control of AIDS, in the Republic of Kazakhstan, 45.8% of patients in the symptomatic stages of HIV infection are diagnosed with tuberculosis (TB) which is the cause of death in 36% of patients infected with HIV.

The aim of the study was to conduct a retrospective analysis of the effectiveness of tuberculosis (TB) chemoprophylaxis among people living with HIV in the Republic of Kazakhstan (RK) in Central Asia.

Material and methods:
Materials and method. A retrospective analysis of patient health status was performed for each of the 648 patients (323 in the study group and 325 in the control group) during 2010–2015. Data from outpatient treatment charts were used concerning each patient infected with HIV observed at AIDS Treatment Centres. From among the 648 patients infected with HIV, 136 were receiving isoniazid in 2010, and 187 in 2011. The control group consisted of 325 people living with HIV (PLW HIV), who did not received isoniazid during observation.

Results. The incidence of TB in patients who underwent chemoprophylaxis did not exceed 0.555/ 100,000 population in the first year of observation. Within 5 years, the TB incidence dropped to 0. In the control group, the TB incidence rate during the first year of observation was 3.262/100,000, with a decrease to 0.364 observed in 2015. Cumulated incidence rate in 2011–2015 in the study group accounted for 1.276/100,000. In the control group, the cumulative incidence was 4.3 times higher and accounted for 5.527. A significant difference in the mortality rate due to TB in the study and control groups was observed, the share of deaths due to TB in study group was 21.6% – nearly 3 times lower than in the control group (57.0%).

Conclusions. The effectiveness of chemoprophylaxis for TB depends on biomedical, organizational and cultural factors. The presence of HIV co-infections is a special situation. Opposite to the majority of reports, in own study, no drug-resistant forms of tuberculosis were observed in relation with chemoprophylaxis with isoniazid. In the examined population, TB chemoprophylaxis reduced the incidence and cumulative incidence of TB among PLW HIV by 3.4–4.8 times. Isoniazid chemoprophylaxis decreased 4-fold the annual and cumulative mortality due to TB.

AIDS – Acquired Immune Deficiency Syndrome HIV – Human Immunodeficiency Virus TB – tuberculosis RK – Republic of Kazakhstan PLW HIV – people living with HIV WHO – World Health Organization IPT – Isoniazid prophylactic therapy MDR – multi drug-resistant IDU – injection drug user ARV – anti-retroviral (drug) CD4 – cluster of differentiation 4 PCR – polymerase chain reaction RR – relative risk n – numbers M – arithmetic mean SD – standard deviation 6EH – Isoniazid (H) combination for 6 months 36H – Isoniazid (H) combination for 36 months TST – tuberculin skin test ART. – anti-retroviral therapy STD – sexually transmitted diseases
Juszkiewicz K, Jarosz MJ, Włoszczak-Szubzda A, Głowacka M. Effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS – retrospective analysis of data from Almaty, Kazakhstan, 2010–2015. Ann Agric Environ Med. 2020; 27(4): 695–701. doi: 10.26444/aaem/118611
WHO. Global Tuberculosis control. Geneva 2018. (access: 20–29.11.2018).
Padmapriyadarsini C, Narendran G, Swaminathan S. Diagnosis & treatment of tubercu-losis in HIV co-infected patients. Indian J Med Res. 2011; 134(6): 850–865.
Stagg HR, Lipman MC, McHugh TD, Jenkins HE, Isoniazid resistant tuberculosis – a cause for concern? Int J Tuberc Lung Dis. 2017; 1; 21(2): 129–139.
WHO – Recommendation on 36 months isoniazid preventive therapy to adults and ado-lescents living with HIV in resource-constrained and high TB and HIV-prevalence set-tings: 2015 update. (access: 20–29.11.2018).
KIT – Royal Tropical Institute project: Addressing Drug-Resistant Tuberculosis in Kazakhstan. (access: 24.06.2019).
Juszkiewicz K, Jarosz MJ, Włoszczak-Szubzda A, Głowacka M. Comparative analysis of the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS treated with isoniazid. Ann Agric Environ Med. 2019; 26(3): 462–467.
Johnson JL, Okwera A, Hom DL, Mayanja H, MutuluuzaKityo C, Nsubuga P, et al. Duration of efficacy of treatment of latent tuberculosis infection in HIV-infected adults. AIDS. 2001; 15(16): 2137–2147.
Quigley MA, Mwinga A, Hosp M, Lisse I, Fuchs D, Porter JDH, et al. Long-term effect of preventive therapy for tuberculosis in a cohort of HIV-infected Zambian adults. AIDS. 2001; 15(2): 215–222.
Person AK, Sterling TR. Treatment of Latent Tuberculosis Infection in HIV: Shorter or Longer? Curr HIV/AIDS Rep. 2012; 9(3): 259–266.
Samandari T, Agizew TB, Nyirenda S, Tedla Z, Sibanda T, Shang N, Mosimaneotsile B, Motsamai OI, Bozeman L, Davis MK, Talbot EA, Moeti TL, Moffat HJ, Kilmarx PH, Castro KG, Wells CD. 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, double-blind, placebo-controlled trial. Lancet. 2011; 377(9777): 1588–98.
Swaminathan S, Menon PA, Gopalan N, Perumal V, Santhanakrishnan RK, Ramachandran R, Chinnaiyan P, Iliayas S, Chandrasekaran P, Navaneethapandian PD, Elangovan T, Pho MT, Ware F, Paranji Ramaiyengar N. Efficacy of a six-month versus a 36-month regimen for prevention of tuberculosis in HIV-infected persons in India: a randomized clinical trial. PLoS One. 2012; 7(12): e47400.
Getahun H, Granich R, Sculier D, Gunneberg C, Blanc L, Nunn P, Raviglione M. Bar-riers and solutions, AIDS. 2010; 24 (suppl 5): S57–S65.
Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2010; 1(CD000171).
Balcells ME, Thomas SL, Godfrey-Faussett P, Grant AD. Isoniazid preventive therapy and risk for resistant tuberculosis. Emerg Infect Dis. 2006; 12: 744–751.
Briggs MA, Emerson C, Modi S, Taylor NK, Date A., Use of isoniazid preventive therapy for tuberculosis prophylaxis among people living with HIV/AIDS: a review of the literature. J Acquir Immune Defic Syndr. 2015; 68 (Suppl3): S297–305.
Ayele HT, Mourik MS, Debray TP, Bonten MJ. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults: A Systematic Review and Meta-Analysis of Randomized Trials. PLoS One. 2015; 9; 10(11): e0142290.
Semu M, Fenta TG, Medhin G, Assefa D. Effectiveness of isoniazid preventative therapy in reducing incidence of active tuberculosis among people living withHIV/AIDS in public health facilities of Addis Ababa, Ethiopia: a historical cohort study. BMC Infect Dis. 2017; 3; 17(1): 5.
Abossie A, Yohanes T. Assessment of isoniazid preventive therapy in the reduction of tuberculosis among ART patients in Arba Minch Hospital, Ethiopia. Ther Clin Risk Manag. 2017; 13: 361–366.
Maharaj B, Gengiah TN, Yende-Zuma N, Gengiah S, Naidoo A, Naidoo K. Imple-menting Isoniazid Preventive Therapy in a TB-treatment experienced cohort on ART. Int J Tuberc Lung Dis. 2017; 01; 21(5): 537–543.
Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS. Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis. Am J Prev Med. 2018; 55(2): 244–252.