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According to Richard Chaisson, MD,
study researcher and director of the Center for Tuberculosis Research at Johns
Hopkins University, routine TB testing in HIV-infected individuals and use of
preventive isoniazid worked at the community level in stopping TB transmission
and reducing mortality.
Chaisson and colleagues conducted a
cluster-randomized trial with 12,816 patients ages 16–84 years at 29 HIV
clinics in Brazil. The researchers selected the clinics at random times to use
an intervention that included training staff to screen HIV-infected patients
for TB, administer TB skin tests, and treat latent TB infection. During the
study, 475 patients developed TB and 838 patients died. Due to the
intervention, more patients received skin tests, 19 per 100 person-years to 59
per 100 person-years. In participants eligible for isoniazid therapy, the rate
increased from 36 per 100 person-years to 144 per 100 person-years.
After the intervention, researchers
noted a 24-percent decrease in TB or death and a 13-percent decrease in new TB
cases. When researchers controlled for characteristics such as age, sex, CD4
count, and use of antiretroviral therapy, they found a 31-percent decrease in
TB or death and a 27-percent decrease in new TB cases. Analysis of patients who
remained in contact with a clinic showed a 55-percent decrease in TB or death
and a 58-percent decrease in active TB.
According to researchers, initial TB
screening as part of the intervention diagnosed TB in 250 of 725 participants.
They were excluded from analyses. Johns Hopkins Epidemiologist Jonathan Golub,
PhD, MPH stated that the results emphasized the effectiveness of TB screening
in community health programs similar to the program used in the study and that
the findings showed that HIV-infected patients benefited if healthcare
providers screened them for active and latent TB and treated, and those
benefits affected disease and mortality in the HIV population.
The full report, “Effect of Improved
Tuberculosis Screening and Isoniazid Preventive Therapy on Incidence of
Tuberculosis and Death in Patients with HIV in Clinics in Rio de Janeiro,
Brazil: A Stepped Wedge, Cluster-Randomised Trial,” was published online in the
journal Lancet Infectious Diseases (2013; doi: 10.1016/S1473-3099(13)70187-7).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus.
To learn more about The Friends of
AIDS Foundation, please visit: http://www.friendsofaids.org.
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