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Isoniazid preventive therapy during infancy does not adversely effect growth among HIV-exposed uninfected children:
Ashenafi S Cherkos1, Sylvia M LaCourse2,3,4, Daniel A Enquobahrie2
1Biostatistics and Epidemiology Department, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA.
Insights
Isoniazid preventive therapy (IPT) did not affect long-term infant growth in HIV-exposed, uninfected infants. This tuberculosis prevention strategy showed no significant impact on weight-for-age or height-for-age z-scores up to two years.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Isoniazid preventive therapy (IPT) is known to reduce tuberculosis (TB) risk.
- The long-term effects of IPT on infant growth, particularly in HIV-exposed but uninfected (HEU) infants, remain largely unknown.
- This study investigated the impact of IPT on infant growth trajectories in a high-risk population.
Approach:
- A randomized controlled trial (RCT) involving 298 HIV-exposed uninfected infants in Kenya was conducted.
- Infants received either 12 months of daily isoniazid preventive therapy (IPT) or no intervention.
- Growth outcomes, including weight-for-age z-score (WAZ) and height-for-age z-score (HAZ), were assessed using linear mixed-effects models up to 24 months of age.
Key Points:
- No significant differences in WAZ or HAZ were observed between the IPT and control groups throughout the 24-month follow-up.
- Growth trajectories for WAZ and HAZ were similar across both trial arms, including in sex-stratified analyses.
- While overall growth declined in all infants, IPT administration did not alter these patterns or lead to adverse growth outcomes.
Conclusions:
- Isoniazid preventive therapy (IPT) administered to HIV-exposed uninfected infants does not significantly impact their growth in the first two years of life.
- The findings suggest that IPT can be safely used in this population without compromising key growth indicators.
- Further research may explore other long-term health outcomes associated with IPT in HEU infants.
Background:
Isoniazid preventive therapy (IPT) decreases risk of tuberculosis (TB) disease; impact on long-term infant growth is unknown. In a recent randomized trial (RCT), we assessed IPT effects on infant growth without known TB exposure.
Methods:
The infant TB Infection Prevention Study (iTIPS) trial was a non-blinded RCT among HIV-exposed uninfected (HEU) infants in Kenya. Inclusion criteria included age 6-10 weeks, birthweight ≥2.5 kg, and gestation ≥37 weeks. Infants in the IPT arm received 10 mg/kg isoniazid daily for 12 months, while the control trial received no intervention; post-trial observational follow-up continued through 24 months of age. We used intent-to-treat linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) between trial arms.
Results:
Among 298 infants, 150 were randomized to IPT, 47.6% were females, median birthweight was 3.4 kg (interquartile range [IQR] 3.0-3.7), and 98.3% were breastfed. During the 12-month intervention period and 12-month post-RCT follow-up, WAZ and HAZ declined significantly in all children, with more HAZ decline in male infants. There were no growth differences between trial arms, including in sex-stratified analyses. In longitudinal linear analysis, mean WAZ (β=0.04 [95% CI:-0.14, 0.22]), HAZ (β=0.14 [95% CI:-0.06, 0.34]), and WHZ [β=-0.07 [95% CI: -0.26, 0.11]) z-scores were similar between arms as were WAZ and HAZ growth trajectories. Infants randomized to IPT had higher monthly WHZ increase (β to 24 months 0.02 [95% CI:0.01, 0.04]) than the no-IPT arm.
Conclusion:
IPT administered to HEU infants did not significantly impact growth outcomes in the first two years of life.
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