Strategies for isoniazid preventive therapy in HIV-positive patients who consume alcohol

BACKGROUND WHO guidance to defer isoniazid preventive therapy (IPT) among those with regular alcohol use because of hepatotoxicity concerns may exclude many people living with HIV (PLWH) at high TB risk in these settings. OBJECTIVE To evaluate hepatotoxicity during TB preventive therapy (TPT) in PLW...

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Bibliographic Details
Published in:	The international journal of tuberculosis and lung disease Vol. 28; no. 7; pp. 335 - 342
Main Authors:	Savinkina, A., Muyindike, W., Hahn, J.A., Emenyonu, N.I., Fatch, R., Ngabirano, C., Adong, J., Jacobson, K.R., Linas, B.P.
Format:	Journal Article
Language:	English
Published:	France International Union Against Tuberculosis and Lung Disease 01-07-2024 International Union against Tuberculosis and Lung Disease (IUATLD)
Subjects:	Adult Alcohol Drinking - adverse effects Alcohol Drinking - epidemiology Alcohol Use Alcohols Antitubercular Agents - administration & dosage Antitubercular Agents - adverse effects Chemical and Drug Induced Liver Injury - epidemiology Chemical and Drug Induced Liver Injury - etiology Chemical and Drug Induced Liver Injury - prevention & control Female Health risks Hepatotoxicity HIV HIV Infections - drug therapy Human immunodeficiency virus Humans IPT Isoniazid Isoniazid - administration & dosage Latent Tuberculosis - drug therapy Liver Toxicity Male Markov Chains Middle Aged Monitoring Preventive medicine Skin tests Telemedicine Therapy Tuberculin Tuberculin Test Tuberculosis Tuberculosis - epidemiology Tuberculosis - prevention & control Uganda - epidemiology Young Adult Uganda
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Summary:	BACKGROUND WHO guidance to defer isoniazid preventive therapy (IPT) among those with regular alcohol use because of hepatotoxicity concerns may exclude many people living with HIV (PLWH) at high TB risk in these settings. OBJECTIVE To evaluate hepatotoxicity during TB preventive therapy (TPT) in PLWH who report alcohol use in Uganda over 10 years. METHODS We developed a Markov model of latent TB infection, isoniazid preventive therapy (IPT - a type of TPT), and TB disease using data from the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) study. We modeled several treatment scenarios, including no IPT, IPT with liver enzyme monitoring (AST/ALT) during treatment, and IPT with pre-screening using the tuberculin skin test (TST). RESULTS The no IPT scenario had 230 TB deaths/100,000 population over 10 years, which is more than that seen in any IPT scenario. IPT, even with no monitoring, was preferred over no IPT when population TB disease incidence was >50 in 100,000. CONCLUSIONS For PLWH who report alcohol use in high TB burden settings, IPT should be offered, ideally with regular AST/ALT monitoring. However, even if regular monitoring is not possible, IPT is still preferable to no IPT in almost every modeled scenario.
Bibliography:	(R) Medicine - General 1027-3719(20240701)28:7L.335;1- ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1027-3719 1815-7920 1815-7920
DOI:	10.5588/ijtld.23.0303