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

• 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
• ISSN: 1027-3719; 1815-7920; 1815-7920
• DOI: 10.5588/ijtld.23.0303

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.