17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

THE EXPERIENCE AND OUTCOMES OF ISONIAZID PREVENTATIVE THERAPY IN AN HIV TREATMENT PROGRAM IN WESTERN KENYA

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MoAb0306

L. Diero ¹, E.J. Carter², A. Siika¹, S. Kimaiyo¹, A. Gardner³, B. Musick⁴, C. Yiannoutsos⁴, K. Wools-Kaloustian^4
1Moi University School of Medicine, Eldoret, Kenya, ²Brown Univerisy, Providence, United States, ³Harvard University, Boston, United States, ⁴Indiana University School of Medicine, Indianapolis, United States

BACKGROUND: Implementation of isoniazid (INH) preventative therapy (IPT) for latent tuberculosis in HIV-patients in sub-Saharan Africa has been slow due to issues related to scale-up including concerns about monotherapy in those with active tuberculosis.

METHODS: To determine the outcomes of IPT provided within an HIV treatment program in western Kenya, electronic medical records for adults enrolled between September 2004 and February 2007 were reviewed. IPT is provided if patients screen negative on enrollment respiratory system symptom/exam screen and chest x-ray as well as having not previously received tuberculosis treatment. Analysis of data included comparison of categorical factors through chi-square tests, estimation of survival times by Kaplan-Meier method and multivariate analysis using Cox proportional hazards model.

RESULTS: IPT was initiated in 9633 of 29,197 (33.0%) adults with 7096 meeting endpoints of INH completion (9-months) (5387; 76%) or premature termination (1709; 24%) and the remainder continuing IPT. Characteristics of IPT patients are: 72.2% female, median age 36.8 (IQR 30.8-43.7), 44.5% attended urban clinic, median CD4 count 280 (IQR 153-432), 21.7% WHO Stage 3/4, and 32.9% on antiretrovirals. Urban clinic attendance, higher CD4 count and lower WHO stage predicted INH completion. 53 (3%) of terminators did so because of incident tuberculosis. 73 (4.3%) of terminators developed active tuberculosis after INH termination, yielding a 1 and 2-year incidence of 4.6% and 7.7% respectively. Of INH completers 89 (1.7%) subsequently developed tuberculosis. In completers, cumulative 1-year tuberculosis incidence was 2.1% and 4.6% at 2-years. In a multivariate analysis CD4 count <50 (HR: 6.7; p<0.001), 50-99 (HR: 3.1; p=0.01), CD4 100-199 (HR 1.7; p=0.05) (referent: CD4 >200) and termination of INH prophylaxis (HR 2.2; p=0.001) (referent: completion) was associated with incident active tuberculosis.

CONCLUSIONS: IPT within a large HIV treatment program in sub-Saharan Africa appears both feasible and effective in preventing incident episodes of active tuberculosis.

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2008-08-13
MoAb0306

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