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Isoniazid preventive therapy in HIV-infected and -uninfected children (0 - 14 years)

Hendrik S Schaaf1, Mark F Cotton, Gerald P G Boon

  • 1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. hss@sun.ac.za.

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|October 2, 2013
PubMed

Insights

Isoniazid preventive therapy (IPT) can prevent tuberculosis (TB) in children exposed to TB. For HIV-infected children, IPT is recommended after TB exposure, regardless of age or antiretroviral therapy status.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Isoniazid preventive therapy (IPT) is effective in preventing tuberculosis (TB) in immunocompetent children under 5 years old following TB exposure.
  • The use of routine IPT in all HIV-infected children without active TB has been debated.
  • Antiretroviral therapy (ART) significantly lowers TB risk in HIV-infected children, particularly when initiated early.

Purpose of the Study:

  • To evaluate the efficacy and recommendations for isoniazid preventive therapy (IPT) in HIV-infected children.
  • To clarify the role of IPT in both exposed and unexposed HIV-infected children.

Main Methods:

  • Review of existing evidence on IPT in HIV-infected and HIV-uninfected children.
  • Analysis of the impact of antiretroviral therapy on TB risk in HIV-infected children.

Main Results:

  • IPT is recommended for HIV-infected children after each episode of TB exposure, irrespective of age or ART status.
  • Routine IPT for HIV-infected children without known TB exposure is not supported by convincing evidence.

Conclusions:

  • Post-exposure IPT is a crucial intervention for HIV-infected children.
  • Routine IPT without known TB exposure is not recommended for HIV-infected children due to insufficient evidence.

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