Akolo Christopher, Bada Florence, Okpokoro Evaezi, Nwanne Ogochukwu, Iziduh Sharon, Usoroh Eno, Ali Taofeekat, Ibeziako Vivian, Oladimeji Olanrewaju, Odo Michael
Christopher Akolo, Population Services International, Washington, DC 20036, United States.
World J Virol. 2015 May 12;4(2):105-12. doi: 10.5501/wjv.v4.i2.105.
Isoniazid preventive therapy (IPT) is the administration of isoniazid (INH) to people with latent tuberculosis (TB) infection (LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunodeficiency virus (HIV)-infected persons who do not have active TB, IPT is poorly implemented globally due to misconceptions shared by healthcare providers and policy makers. However, amongst HIV-infected patients especially those living in resource-limited settings with a high burden of TB, available evidence speaks for IPT: Among HIV-infected persons, active TB- the major contraindication to IPT, can be excluded with symptom screening; chest X-ray and tuberculin skin testing are unreliable and often lead to logistic delays resulting in increased numbers of people with LTBI progressing to active TB; the use of IPT has not been found to increase the risk of the development of INH mono-resistance; IPT is cost-effective and cheaper than the cost of treating cases of active TB that would develop without IPT; ART and IPT have an additive effect on the prevention of TB, and both are safe and beneficial even in children. In order to sustain the recorded gains from ART scale-up and to further reduce TB-related morbidity and mortality, more efforts are needed to scale-up IPT implementation globally.
异烟肼预防性治疗（IPT）是指对潜伏性结核感染（LTBI）人群给予异烟肼（INH）以预防进展为活动性结核病。尽管IPT对未患活动性结核病的人类免疫缺陷病毒（HIV）感染者来说是挽救生命的措施，但由于医疗服务提供者和政策制定者存在的误解，IPT在全球范围内实施情况不佳。然而，在HIV感染者中，尤其是那些生活在结核病负担沉重的资源有限环境中的感染者，现有证据支持IPT：在HIV感染者中，活动性结核病——IPT的主要禁忌症，可通过症状筛查排除；胸部X光检查和结核菌素皮肤试验不可靠，且常常导致后勤延误，致使更多LTBI患者进展为活动性结核病；尚未发现使用IPT会增加INH单耐药发生的风险；IPT具有成本效益，且比不进行IPT而治疗可能发生的活动性结核病例的费用更低；抗逆转录病毒治疗（ART）和IPT在预防结核病方面具有相加作用，甚至对儿童来说两者都是安全且有益的。为了维持扩大ART规模所取得的既定成效，并进一步降低与结核病相关的发病率和死亡率，需要做出更多努力在全球范围内扩大IPT的实施。
