HIV: the benefits of prophylaxis of TB are confirmed
Long-term follow-up in the ANRS TEMPRANO trial confirms that tuberculosis chemoprophylaxis in HIV-infected people is more than ever relevant in resource-limited countries. This prophylactic use of drugs reduces mortality, even among people taking antiretroviral treatment who have a high CD4+ T cell count. ANRS TEMPRANO was conducted by researchers of the Ivory Coast ANRS site, which comprises teams from Inserm (U1219, University of Bordeaux), the Infectious and Tropical Diseases Department of the Treichville University Hospital, and 8 other infection treatment centers in Abidjan. The results of this trial are published in the 9 October 2017 issue of The Lancet Global Health and should encourage countries where the burden of tuberculosis is heavy to apply the relevant WHO recommendations.
Tuberculosis is the leading cause of death among HIV-infected people in sub-Saharan Africa. In the 1990s, several studies showed that HIV-infected people who take the antibiotic isoniazid, for 6 to 12 months, are at lower risk of developing tuberculosis. On the basis of these studies, since 1993 the WHO has recommended that people living with HIV in countries where tuberculosis is rife should take isoniazid for 6 months. However, this recommendation has been little applied because it was deemed obsolete following the advent of antiretrovirals that restore immunity and hence lower the risk of tuberculosis. ANRS TEMPRANO has reassessed the benefits of isoniazid prophylaxis in the era of early antiretroviral treatment.
ANRS TEMPRANO was coordinated by Dr Xavier Anglaret and
Professor Serge Eholie and conducted by researchers from the
Ivory Coast ANRS site, which comprises teams from Inserm (U1219,
University of Bordeaux), the Infectious and Tropical Diseases
Department of the Treichville University Hospital, and 8 other
HIV care centers in Abidjan. Sponsored and mainly funded by the
ANRS, ANRS TEMPRANO, which was conducted between 2008 and 2015,
showed that 6-month isoniazid prophylaxis for tuberculosis and
early antiretroviral treatment both reduced the risk of severe
morbidity in the first two years of follow-up. Published in The
New England Journal of Medicine in 2015, these results greatly
contributed to the formulation of WHO treatment recommendations.
ANRS TEMPRANO participants were then followed up for an average
of 4.5 years, and the findings are now published in the 9
October 2017 issue of The Lancet Global Health. This long-term
follow-up shows that tuberculosis chemoprophylaxis reduces not
only severe morbidity, but also mortality, and that this
benefit, which is independent of and complementary to that of
antiretroviral treatment, lasts at least 6 years after
administration.
Professor François Dabis, the Director of the ANRS, notes
that "We now have irrefutable evidence of the value of
tuberculosis chemoprophylaxis in HIV-infected people in
resource-limited countries in the era of antiretrovirals, even
when these are initiated very early. The WHO recommendations
should more than ever be applied."
Sources:
Badje A, Moh R, Gabillard D, et al. Effect of isoniazid preventive therapy on risk of death in west African HIV-infected adults with high CD4 count: long-term follow up of the Temprano ANRS 12136 trial. Lancet Glob Health 2017; 5: e1080–89
Accompanying comment:
Preventing tuberculosis in people with HIV—no more
excuses. Lancet Glob Health 2017
Source:
ANRS
