Are the effects of isoniaid preventive therapy and highly active antiretroviral therapy additive in preventing HIV-associated tuberculosis

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University of Cape Town

Golub et al. [1] recently reported a retrospective analysis of rates of incident tuberculosis (TB) in a large observational cohort of 2778 patients accessing HIV care in rural and urban South Africa. The TB incidence rate was highest [7.1/100 person-years; 95% confidence interval (CI)¼ 6.2–8.2] during the period of care when patients did not receive isoniazid preventive therapy (IPT) or highly active antiretroviral therapy (HAART). The rates were lower during person-time that accrued throughout follow-up after initiation of IPT (5.2/100 person-years; 95% CI¼ 3.4–7.8) and throughout follow-up on HAART alone (4.6/100 person-years, 95% CI¼ 3.4– 6.2). The rate was lower still (1.1/100 person-years 95% CI¼ 0.2–7.6) during person-time accrued during sequential IPT and HAART (IPTþ HAART). The authors concluded that TB risk was significantly reduced by IPT in HAART-treated adults. It was further concluded that ‘the dramatic reduction in TB risk’ demonstrated in this study together with supportive data from a similarly analysed study from Brazil [2] indicates that widespread use 1444 AIDS 2009, Vol 23 No 11 Fig. 1. T2-weighted flair image demonstrating enhancing lesion in the right precentral gyrus. Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. of IPT should be implemented in conjunction with the roll-out of HAART.