Title

Benefit of isoniazide preventive therapy to reduce incident TB, mortality and loss to follow-up in Indonesian five-years cohort

Presenter

Rudi Wisaksana

Authors

R. Wisaksana¹, Y. Hartantri¹, M. Lestari², D. Azzahra², T. Karjadi³, E. Yunihastuti³, A. Ujainah³, H. Agustin⁴, E. Eppy⁴, E. Burhan⁴, M.R.T. Komaryani⁵, E. Hastuti⁶, N. Sulaiman⁷, S. Wiyana⁶, T. Nisa⁸

Institutions

¹Hasan Sadikin Hospital, Internal Medicine Department, Bandung, Indonesia, ²Padjadjaran University, HIV Wiorking Group, Bandung, Indonesia, ³Cipto Mangunkusmo Hospital, Internal Medicine Department, Jakarta, Indonesia, ⁴Persahabatan Hospital, Jakarta, Indonesia, ⁵Marzoeki Mahdi Hopsital, Bogor, Indonesia, ⁶Ministry of Health Indonesia, National AIDS Program, Jakarta, Indonesia, ⁷Ministry of Health Indonesia, National TB Program, Jakarta, Indonesia, ⁸World Health Organization, Jakarta, Indonesia

Background: Isoniazide Preventive Therapy (IPT) have been recommended by WHO since 23 years ago. Despite the recognized benefit from previous studies globally, clinicians in Indonesia considered that implementation study on IPT needs to be performed. National AIDS Program and National TB Program of Indonesia initiated IPT study in 4 top-referral hospital in Indonesia in 2012, to show benefit of IPT in preventing active Tuberculosis (TB) among PLHIV in endemic countries such as Indonesia.
Methods: Group of HIV-infected subjects which receive IPT during 2012-2014 were compared with other group of HIV-infected subjects which not receive IPT matched on age, gender, CD4 cell count and ART status. Both groups followed until 5 years. Outcome of active TB disease was the study primary end point; with all-cause mortality and loss follow-up as secondary end points.
Results: This study found IPT reduce TB incident from IR: 4.4 / 100 person-years (95% CI: 3.2 - 6.1) in non-IPT HIV-patients into IR: 1.2 / 100 person-years (95% CI: 0.5 - 2.6) in the first 3 years. In 5 years TB incident still lower in IPT group with IR: 1.7 / 100 person-years (95% CI: 0.9 - 3.0) compared to non-IPT group, IR: 3.6 / 100 person-years (95% CI: 2.7 - 4.9).
For secondary outcome, this study showed risk of mortality and loss to follow-up lower in IPT group compare to non-IPT group but not significant. History of TB have higher risk of mortality and low adherence have higher risk of loss to follow-up.
Conclusions: This first study from Indonesia has confirmed other previous studies globally on IPT. As a part of TB-HIV collaborations, IPT program must be expanded and promoted to all PLHIV in Indonesia.