AIDS. 2022 Nov 23. doi: 10.1097/QAD.0000000000003436. Online ahead of print.
ABSTRACT
OBJECTIVE: To systematically assess the efficacy, safety, and tolerability of isoniazid preventive therapy (IPT) for tuberculosis (TB) in people living with human immunodeficiency virus (PLHIV).
DESIGN: Systematic review and meta-analysis.
METHODS: A thorough literature search was performed using PubMed, Cochrane CENTRAL, and Google Scholar from their inception to June 30, 2021. All randomized controlled trials (RCTs) investigating the efficacy, safety, or tolerability of IPT on PLHIV compared to placebo or active comparators were included in the study. The heterogeneity among the studies was identified by using the I2 statistic and Cochran’s Q test.
RESULTS: Out of the 924 non-duplicate RCTs identified through database searching and other sources, 26 studies comprising 38005 patients were included. The overall effect estimate identified the reduction of active TB incidence (OR 0.69; 95% CI 0.57, 0.84; P < 0.001), but not all-cause mortality (OR 0.91; 95% CI 0.82, 1.02; P = 0.10) with IPT compared to the control. Additionally, no significant association was identified between the use of IPT and the risk of peripheral neuropathy (OR 1.50; 95% CI 0.96, 2.36; P = 0.08) and hepatotoxicity (OR 1.21; 95% CI 0.97, 1.52; P = 0.09).
CONCLUSIONS: This systematic review and meta-analysis identified a significant reduction in the incidence of active TB, but not all-cause mortality, among PLHIV who received IPT compared to the control. Lesser number of outcomes may be the reason for non-significant results in terms of safety outcomes of IPT. Therefore, there is a need for extensive and long-term studies to address these issues further, especially in TB/HIV endemic areas.
PMID:36412204 | DOI:10.1097/QAD.0000000000003436
