Long-term Protection From Tuberculosis Preventive Treatment Among People With HIV in a High-Burden Tuberculosis...

Area of Science:

• Public Health
• Infectious Diseases
• HIV/AIDS Research

Background:

• Tuberculosis Preventive Treatment (TPT) is a cornerstone of the global End TB Strategy.
• Limited data exist on the long-term effectiveness of TPT for people living with HIV (PLWH) on antiretroviral therapy (ART) in high TB-burden regions.

Purpose of the Study:

• To evaluate the long-term impact of a single course of TPT on TB incidence and mortality.
• To assess the combined effect of TPT completion and effective ART on TB and mortality outcomes in PLWH.

Main Methods:

• An observational cohort study followed 4,706 PLWH initiating TPT in Andhra Pradesh, India, for 6 years.
• TB incidence and mortality rates were calculated per 100 person-years (PY).
• Cox-proportional hazards models were used to estimate adjusted hazard ratios (aHR) for TB and mortality, stratified by TPT completion and effective ART (viral load <1000 copies/ml).

Main Results:

• TPT completion was associated with lower TB incidence (0.55/100 PY) compared to non-completion (1.06/100 PY).
• All-cause mortality was substantially lower among TPT completers (2.2/100 PY) versus non-completers (13.5/100 PY).
• TPT plus effective ART demonstrated an 87% reduction in TB risk (aHR: 0.13) and a 94% reduction in all-cause mortality (aHR: 0.06).

Conclusions:

• A single course of TPT, when combined with effective ART, provides lasting protection against TB in PLWH.
• This combination strategy significantly reduces all-cause mortality in high TB-burden settings.
• Findings support the integration of TPT and effective ART for improved outcomes in PLWH.