Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
Am J Respir Crit Care Med. 2020 Oct 15;202(8):1159-1168. doi: 10.1164/rccm.201908-1576OC.
The World Health Organization recommends the use of isoniazid (INH) alone or in combination with rifapentine to treat latent tuberculosis infections. The recent rise of drug-resistant tuberculosis has complicated the choice of treatment regimen for latent tuberculosis infection. To evaluate the effects of INH preventive therapy on the contacts of patients with multidrug-resistant tuberculosis. In a prospective cohort study conducted between September 2009 and August 2012, we identified 4,500 index patients with tuberculosis and 14,044 tuberculosis-exposed household contacts who we followed for 1 year for the occurrence of incident tuberculosis disease. Although Peruvian national guidelines specify that INH preventive therapy should be provided to contacts aged 19 years old or younger, only half this group received INH preventive therapy. Among 4,216 contacts under 19 years of age, 2,106 contacts (50%) initiated INH preventive therapy at enrollment. The protective effect of INH was more extreme in contacts exposed to drug-sensitive tuberculosis (adjusted hazard ratio, 0.30; 95% confidence interval, 0.18-0.48) and to multidrug-resistant tuberculosis (adjusted hazard ratio, 0.19; 95% confidence interval, 0.05-0.66) compared with those exposed to mono-INH-resistant tuberculosis (adjusted hazard ratio, 0.80; 95% confidence interval, 0.23-2.80). In the second independent study, tuberculosis occurred in none of the 76 household contacts who received INH preventive therapy compared with 3% (8 of 273) of those who did not. Household contacts who received INH preventive therapy had a lower incidence of tuberculosis disease even when they had been exposed to an index patient with multidrug-resistant tuberculosis. INH may have a role in the management of latent multidrug-resistant tuberculosis infection.
世界卫生组织建议使用异烟肼（INH）单独或与利福喷汀联合治疗潜伏性结核感染。最近耐药结核病的增加使潜伏性结核感染的治疗方案选择变得复杂。评估 INH 预防性治疗对耐多药结核病患者接触者的影响。在 2009 年 9 月至 2012 年 8 月期间进行的一项前瞻性队列研究中，我们确定了 4500 例肺结核患者和 14044 例肺结核接触者家庭接触者，我们对他们进行了为期 1 年的随访，以观察新发结核病的发生。尽管秘鲁国家指南规定应向 19 岁或以下的接触者提供 INH 预防性治疗，但只有一半的接触者接受了 INH 预防性治疗。在 4216 名 19 岁以下的接触者中，有 2106 名（50%）在入组时开始接受 INH 预防性治疗。与接触单 INH 耐药结核（调整后的危险比为 0.30；95%置信区间为 0.18-0.48）和耐多药结核（调整后的危险比为 0.19；95%置信区间为 0.05-0.66）相比，INH 的保护作用更为显著与接触单 INH 耐药结核（调整后的危险比为 0.80；95%置信区间为 0.23-2.80）。在第二项独立研究中，接受 INH 预防性治疗的 76 名家庭接触者中无一例发生结核病，而未接受治疗的 273 名家庭接触者中 3%（8 例）发生结核病。即使接触了耐多药结核病患者，接受 INH 预防性治疗的家庭接触者结核病的发病率也较低。INH 可能在耐多药潜伏性结核感染的管理中发挥作用。
