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allied
academies
September 20-21, 2017 | Philadelphia, USA
Global summit on
TUBERCULOSIS AND LUNG DISEASE
Int J Respir Med 2017 Volume 2 Issue 2
Introduction:
Isoniazide preventive therapy (IPT) is a proven means to prevent
tuberculosis (TB) disease from surfacing among people living with HIV (PLHIV).
However, there is concern that patients often develop tuberculosis disease while
receiving IPT, defined here as breakthrough tuberculosis, which may affect follow-up
outcome. In this study, we evaluated the magnitude and determinants of breakthrough
tuberculosis.
Methods:
A multisite retrospective cohort study from year 2005 to 2013 involving
11 randomly selected hospitals from Addis Ababa, SNNPR, and Gambela regions of
Ethiopia was carried out to assess the occurrence of breakthrough tuberculosis.
Multinomial logistic regression was used to study factors associated with it.
Results:
4,484 patients in chronic HIV care received IPT of which 80% also received
antiretroviral therapy (ART). 88/4,484 (1.9%) patients developed tuberculosis of which
29/4,484 (0.6%) were diagnosed while receiving IPT. The incidence of breakthrough
tuberculosis was 2.3 per 1000 person-years of observation (95% CI: 1.6-3.3 per 1000
PY). 7/29 (24%) breakthrough TB cases were diagnosed within the first month of
IPT initiation. 9/19 (47%) breakthrough TB cases were diagnosed within the first six
months of ART initiation. Baseline CD4 count ≥350 and being on ART were associated
with having less odds of developing breakthrough TB (OR=0.1 (95%CI: 0.1-0.2), p
value<0.01).
Conclusion:
Breakthrough TB was uncommon in the study setting. A significant
proportion of it occurred in the first month of treatment and could be due to difficulty
to diagnose TB with AFB+/- Chest X-ray or failure to strictly follow TB screening
algorithm to rule out TB after adequate follow-up.
e:
Kesetebirhan.Delele@kncvtbc.orgHow common is breakthrough tuberculosis disease among people with HIV receiving Isoniazide
preventive therapy? Observations from a multisite study in Ethiopia
Kesetebirhan Delele Yirdaw
USAID/Challenge TB Project, SNNPR, Ethiopia