Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use.

Autor:	Hahn JA; Department of Medicine.; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA., Ngabirano C; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda., Fatch R; Department of Medicine., Emenyonu NI; Department of Medicine., Cheng DM; School of Public Health, Boston University School of Public Health, Boston, Massachusetts., Adong J; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda., Tumwegamire A; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda., Terrault NA; Keck School of Medicine, University of Southern California, Los Angeles, California., Linas BP; Boston University Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA., Jacobson KR; Boston University Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA., Muyindike WR; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.; Mbarara Regional Referral Hospital, Mbarara, Uganda.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2023 Aug 01; Vol. 37 (10), pp. 1535-1543. Date of Electronic Publication: 2023 May 29.
DOI:	10.1097/QAD.0000000000003613
Abstrakt:	Objective: Isoniazid (INH) preventive therapy is recommended to prevent tuberculosis (TB) disease for persons with HIV (PWH), except for those with regular and heavy alcohol consumption, due to hepatotoxicity concerns. We aimed to quantify the incidence of severe INH-related toxicity among PWH with and without recent alcohol consumption. Design: A prospective study of PWH receiving INH. Methods: We included PWH in southwest Uganda with recent (prior 3 months) ( n  = 200) or no (prior year) self-reported alcohol consumption ( n  = 101), on antiretroviral therapy, TB infected (≥5 mm on tuberculin skin test), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2× or less the upper limit of normal (ULN). Grade 3+ INH-related toxicity was ALT or AST at least 5× the ULN or severe symptoms; we stopped IPT upon detection. Grade 2 INH-related toxicity was ALT or AST 2-5× the ULN or moderate symptoms. Results: The cumulative incidence of Grade 3+ INH-related toxicity was 8.3% [95% confidence interval (95% CI) 5.4-12.0]; all resolved after INH cessation. Incidence was 6.0% (95% CI 3.1-10.2) among those reporting recent alcohol use and 12.9% (95% CI 7.0-21.0) among those reporting no prior year alcohol use. We found no differences by baseline phosphatidylethanol-confirmed alcohol severity. The cumulative incidence of Grade 2 toxicities (without Grade 3+) was 21.7% (95% CI 17.0-27.1); 25.0% (95% CI 19.0-31.8) among those with recent alcohol use and 14.8% (95% CI 8.1-23.9) among those with no prior year alcohol use. Conclusion: Alcohol use does not appear to increase risk for serious INH-related toxicity among PWH without significant liver enzyme elevations at baseline (≤2x ULN). (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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