TB drug IPT found to reduce HIV patients' risk of death 37%

According to the Temprano ANRS 12136 study, people living with HIV who took a six-month course of isoniazid preventative treatment (IPT) reduced their risk of death by 37% over an average follow-up period of 4.5 years.

Isoniazid, which is used in treating tuberculosis, can also help prevent the emergence of active tuberculosis in people who are TB carriers. Latent TB infections are more likely to develop into active TB if the immune system is compromised, whether by malnutrition, aging, or HIV infection. IPT has been found in several studies to reduce the risk of TB and death in people living with HIV and not taking antiretroviral therapy (ART). In 2011, the World Health Organization recommended a 36-month course of IPT for those living with HIV.

The Temprano study, whose results were reported by Anani Badje at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI), also showed that six months of IPT treatment reduced the risk of any severe HIV-related illness or death by 35%, independent of ART.

2056 people participated in the IPT portion of the study, and were randomly selected to receive six months of either IPT or a placebo. Of these people, 42% had CD4 cell counts above 500 cells/mm3.

The 6-year probability of death was 6.9% in the no-IPT group (95% CI 5.1%-9.2%) and 4.1% in the IPT group (95% CI 2.9%-5.7%). IPT reduced the risk of death by 37% (hazard ratio 0.63, 95% CI 0.41-0.97).

According to Dr. Badje, the results of the study provide strong evidence that IPT should be recommended to people living with HIV. Some countries are still reluctant to make that recommendation for fear of isoniazid resistance. Dr. Badje spoke of the need to overcome this reluctance by instituting a strong and clear policy of treating people living with HIV with IPT.