The impact of tuberculosis preventive therapy on tuberculosis and death in HIV-infected children

Tuberculosis (TB) is a common cause of severe lung disease and death in children infected with HIV, particularly those living in areas of high tuberculosis prevalence. Hence preventing TB infection and disease in HIV-infected children is desirable and potentially an important major public health intervention. Isoniazid, a medication used in the treatment of TB, has been effectively used to prevent TB in HIV-uninfected children exposed to TB. However, it is unclear what impact TB preventive therapy such as isoniazid has on the rate of TB or death if given to HIV-infected children with and without exposure to TB. This review aimed to assess the impact of any TB preventive therapy on the rate of TB or death when given to HIV-infected children. We found only one published randomised controlled trial investigating TB preventive therapy in HIV-infected children. The trial showed a marked reduction in TB incidence and death in the group of children who received isoniazid as primary preventive therapy. Few adverse events occurred during the study and none were related to the isoniazid therapy. However there are currently no long-term follow up data on the durability of the protective effect or possible long term adverse events. This trial was also unable to assess the impact of isoniazid prophylaxis on children receiving antiretroviral therapy. Further studies are needed to assess whether TB preventive therapy is of benefit in all HIV-infected children irrespective of use of antiretroviral treatment; the optimal duration of preventive therapy or long term adverse effects.