Frigati LJ, Kranzer K, Cotton MF, Schaaf HS, Lombard CJ, Zar HJ. The impact of isoniazid preventive therapy and antiretroviral therapy on tuberculosis in children infected with HIV in a high tuberculosis incidence setting. Thorax. 2011 Apr 2. [Epub ahead of print]
This week, the focus is on pediatrics and tuberculosis with several studies published on the subject. Frigati, et al., wanted to determine if isoniazid preventive therapy (IPT) combine with antiretroviral therapy (ART) would reduce TB in HIV-infected children. In previous research, combining IPT and ART showed a 76% reduction in risk of TB in HIV-infected adults compared to those not on either treatment.
The study found that that IPT combined with ART greatly reduced the risk of TB significantly compared to children receiving only IPT or only ART. This finding could have implications for policy recommendations for children on ART. The screening of children for active TB disease is important to reduce the emergence of resistance. Other interesting points include:
- Infants with HIV have a 24-fold higher risk of getting TB than infants without HIV infection.
- Children with HIV and TB have a greater risk of more severe disease, progressing more rapidly to disease, and death.
- The finding from the study, which took place in South Africa, may not apply to low TB prevalence settings.
- For the analysis, Cox proportional hazards regression was used and hazard ratios generated.
- Since young children are more likely to develop disease from a primary infection and not reactivation of latent infections, IPT may help contain primary infection in children receiving ART.
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