Shorter regimen ‘prevents TB in people with HIV’

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Copyright: Image by Vachagan Malkhasyan from Pixabay

Speed read

  • Africa and South-East Asia bear the brunt of the world’s TB burden
  • To prevent TB in people with HIV, a three-month course of two drugs is as effective as that for a year
  • Findings are reassuring but more studies are needed in different settings

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[NAIROBI] Taking a single course of two TB drugs — rifapentine and isoniazid — for three months is as effective as taking it for a year in preventing TB among people living with HIV, a study has found.
According to the World Health Organization, 44 per cent of new TB cases worldwide occurred in South-East Asia in 2018, with the Africa region having 24 per cent of the new cases.

From the WHO statistics there were 1.5 million deaths from TB in 2018, including 251,000 people with HIV.

To prevent TB in people living with HIV and taking antiretrovirals, the WHO recommends isoniazid for six months or rifapentine and isoniazid for three months, the study adds.

“But current treatment options are too long and potentially more toxic. These findings will allow us to move forward.”

Gavin Churchyard, Aurum Institute

But with the evidence in high TB burden countries inadequate, researchers aimed to assess the effectiveness of the different regimens over different durations in Ethiopia, Mozambique and South Africa.
“A single round of 3HP [rifapentine and isoniazid for three months] was as effective as taking continuous isoniazid preventive therapy,” says Gavin Churchyard, group CEO of South Africa-based Aurum Institute and principal investigator of the study.  
The study presented at the Conference on Retroviruses and Opportunistic Infections this month (8-11 March) in the United States, was conducted from January 2016 to February 2019 among 4,014 people with HIV who were at least two years old.
Churchyard added that over a 24-month period, TB incidence among those who took the two drugs for three months and a year were similar. For example, of the 76 TB events that were recorded, 39 occurred out of 1,802 participants who took the two medicines for three months whereas 37 were recorded among 1,808 who took them for a year.
Treatment completion of rifapentine and isoniazid involving 3,610 participants was about 90 per cent while that of the isoniazid involving 404 participants was about 51 per cent, he explained.

Churchyard tells SciDev.Net, “We’ve known for some time that preventive therapy for TB is a critical component of any effort to control the TB epidemic.

“But current treatment options are too long and potentially more toxic. These findings will allow us to move forward with co-administration of 3HP and DTG [ a medicine for treating HIV], offering the best treatment options to those who need it the most.”
The finding paves the way for scale-up of the 3HP treatment in 12 high-burden TB countries: Brazil, Cambodia, Ethiopia, Ghana, India, Indonesia, Kenya, Malawi, Mozambique, South Africa, Tanzania, and Zimbabwe, he added.
According to Churchyard, it will be much easier to just implement a single round of the two drugs rather than having to give it annually.

“People living with HIV and health care workers and policy makers in high burden countries need to be cognisant of the results,” he told SciDev.Net.

Halima Dawood, an honorary senior scientist at the Centre for the AIDS Programme of Research, South Africa, tells SciDev.Net that  the study’s results are reassuring.
Dawood explained that it will be important to see if the findings can replicated in other settings, adding that TB is the commonest cause of mortality in people with HIV infection, especially in Sub-Saharan Africa.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


Gavin Churchyard and others Effectiveness of 3HP annually vs once for HIV-positive people: the WHIP3B trial (Conference on Retroviruses and Opportunistic Infections, 11 March 2020)