Isoniazid for preventing tuberculosis in HIV-infected children
Moleen Zunza1, Diane M Gray2, Taryn Young3,4, Mark Cotton5, Heather J Zar6
1. Stellenbosch University, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape Town, South Africa
2. Red Cross War Memorial Children's Hospital and University of Cape Town, Department of Paediatrics and Child Health, Cape Town, Western Cape, South Africa
3. Stellenbosch University, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Cape Town, South Africa
4. South African Medical Research Council, Cochrane South Africa, Cape Town, South Africa
5. Tygerberg Children's Hospital, Children's Infectious Diseases Clinical Research, Tygerberg, Cape Provice, South Africa
6. Red Cross Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa
Zunza M, Gray DM, Young T, Cotton M, Zar HJ. Isoniazid for preventing tuberculosis in HIV-infected children. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD006418. DOI: 10.1002/14651858.CD006418.pub3.
Access the full-text article here: DOI/10.1002/14651858.CD006418.pub3/full
What was the aim of this review?
To summarise the effects of isoniazid prophylaxis on TB, death, and adverse effects in HIV-positive children.
In areas of high tuberculosis endemicity, isoniazid prophylaxis prevents active TB and death in HIV-positive children who are not on ART.
We conducted a review to assess the effect of TB medication on active TB or death and its safety in HIV-positive children.
What was studied in the review?
TB is a common cause of severe lung disease and death in HIV-positive children. Childhood TB is common in poor countries, especially those with a coexisting burden of HIV/AIDS disease. HIV-positive children have a higher risk of developing TB than HIV-negative children. Isoniazid prevents TB in HIV-positive adults and is currently used in children who are at high risk of developing TB disease after exposure to someone with TB. However, there is limited information on the effect of isoniazid medication in reducing active TB or death if given to HIV-positive children without known TB contact.
We searched for studies up to 17 February 2017, and found three studies published between 2007 and 2014 that addressed the effect of isoniazid medication compared to no medication on active TB and death in 991 HIV-positive children, below the age of 13 years. Most of the children were on antiretroviral therapy (ART) and the studies were conducted in South Africa and Botswana. The median length of follow-up ranged from 5.7 to 34 months.
What are the main results of the review?
In HIV-positive children not taking ART, isoniazid medication reduced the number of children developing active TB by 69% (low certainty evidence), and death by 54% (low certainty evidence).
One trial was conducted in HIV-positive children taking ART, and this did not detect any benefit or harm of isoniazid (very low certainty evidence).
The number of children with adverse effects were similar in children receiving isoniazid medication as the control group in both children on ART and not on ART.
How up to date is the review?
The review authors searched for studies published up to February 2017.