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Isoniazid preventive therapy and risk for resistant tuberculosis
Maria Elvira Balcells1, Sara L Thomas, Peter Godfrey-Faussett
1Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom.
Emerging Infectious Diseases
|May 18, 2006
Summary
Isoniazid preventive therapy (IPT) for tuberculosis may increase the risk of developing isoniazid-resistant TB. While not definitively proven, this systematic review suggests caution and the need to rule out active TB before starting IPT.
Area of Science:
- Public Health
- Infectious Diseases
- Microbiology
Background:
- Tuberculosis (TB) resurgence necessitates effective preventive strategies.
- Isoniazid preventive therapy (IPT) is a key intervention, but concerns exist regarding isoniazid resistance.
- Assessing the risk of isoniazid resistance following IPT is crucial for implementation.
Purpose of the Study:
- To systematically review and assess the effect of primary IPT on the risk of developing isoniazid-resistant TB.
- To synthesize evidence from studies published since 1951 regarding IPT and isoniazid resistance.
- To evaluate the impact of different definitions of isoniazid resistance on study outcomes.
Main Methods:
- Systematic review of published data since 1951.
- Meta-analysis combining results from 13 studies.
- Analysis of data from 18,095 persons in isoniazid groups and 17,985 in control groups.
- Separate consideration of HIV-uninfected and HIV-infected populations.
Main Results:
- Combined analysis of 13 studies showed a summary relative risk of 1.45 (95% CI 0.85-2.47) for isoniazid resistance after IPT.
- Results remained similar when analyzing HIV-uninfected and HIV-infected groups separately.
- Analyses were limited by small sample sizes and incomplete resistance testing.
Conclusions:
- Findings suggest a potential increased risk for isoniazid-resistant TB following IPT, though not definitively proven.
- It is essential to exclude active TB diagnosis before initiating IPT.
- Ongoing surveillance for isoniazid resistance is critical to monitor trends and inform public health strategies.