van Griensven Johan, Choun Kimcheng, Chim Bopha, Thai Sopheak, Lorent Natalie, Lynen Lutgarde
Department of Infectious Diseases, Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia.
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Trop Med Int Health. 2015 Dec;20(12):1823-31. doi: 10.1111/tmi.12609. Epub 2015 Oct 19.
Data on feasibility and completion rates of isoniazid preventive therapy (IPT) in HIV-infected patient in Asia are limited. Within a hospital-based HIV programme in Phnom Penh, Cambodia, we determined the proportion completing IPT and reasons for non-completion.
Retrospective cohort study using HIV/IPT programme data, including all adults starting IPT (300 mg/day self-administered for 24 weeks) from February 2011 to March 2013. All patients underwent symptom screening and further investigations as indicated. After ruling out tuberculosis (TB), IPT was started, with monthly follow-up visits. As per national guideline, IPT was only prescribed for ART-naïve patients. IPT completion was defined as taking IPT for at least 22 of the planned 24 weeks. Stavudine/lamivudine/nevirapine was the preferential first-line ART regimen.
Among 445 ART-naïve patients starting IPT (median age: 35 years (IQR: 31-43), median CD4 count 354 cells/μl (IQR 215-545) and 288 (65%) were female), 214 (48%) started ART after a median of 4 weeks (IQR 2-6) on IPT ('concurrent ART'). Overall, 348 (78%) completed IPT. Among individuals with concurrent ART, the completion rate was 73% (157/214). Those without concurrent ART had a higher completion rate (83%; 191/231; P 0.017). The main reason for non-completion with concurrent ART was drug toxicity (mainly hepatotoxicity/rash), occurring in 22% (48/214). Without concurrent ART, the main reason for non-completion was loss to follow-up (16/231; 7%). Fourteen (3%) patients were diagnosed with TB while on IPT, of whom three had a positive TB culture at baseline. An additional 14 TB cases were diagnosed after IPT completion; four were bacteriologically confirmed.
Although overall completion rates were acceptable, IPT discontinuation due to drug toxicity was common in patients subsequently initiating ART. Future studies should evaluate whether this relates to IPT, ARVs or both, and whether the increased toxicity would justify delaying IPT initiation until stabilisation on ART.
关于亚洲HIV感染患者中异烟肼预防性治疗（IPT）的可行性和完成率的数据有限。在柬埔寨金边一个基于医院的HIV项目中，我们确定了完成IPT的比例及未完成的原因。
采用HIV/IPT项目数据进行回顾性队列研究，纳入2011年2月至2013年3月开始接受IPT（每日自我服用300mg，共24周）的所有成年人。所有患者均按指示进行症状筛查和进一步检查。排除结核病（TB）后开始IPT，并每月进行随访。根据国家指南，IPT仅开给未接受抗逆转录病毒治疗（ART）的患者。IPT完成定义为在计划的24周中至少服用22周。司他夫定/拉米夫定/奈韦拉平是优先选用的一线ART方案。
在445例开始接受IPT的未接受ART治疗的患者中（中位年龄：35岁（四分位间距：31 - 43），中位CD4细胞计数354个/μl（四分位间距215 - 545），288例（65%）为女性），214例（48%）在接受IPT中位4周（四分位间距2 - 6）后开始ART（“同时进行ART”）。总体而言，348例（78%）完成了IPT。在同时进行ART的个体中，完成率为73%（157/214）。未同时进行ART的个体完成率更高（83%；191/231；P = 0.017）。同时进行ART时未完成的主要原因是药物毒性（主要是肝毒性/皮疹），发生率为22%（48/214）。未同时进行ART时，未完成的主要原因是失访（16/231；7%）。14例（3%）患者在接受IPT期间被诊断为TB，其中3例基线时TB培养阳性。另外14例TB病例在IPT完成后被诊断；4例经细菌学确诊。
尽管总体完成率可以接受，但在随后开始ART的患者中，因药物毒性导致的IPT停药很常见。未来的研究应评估这是否与IPT、抗逆转录病毒药物或两者都有关，以及毒性增加是否足以证明将IPT开始时间推迟至ART稳定后是合理的。
