对饮酒的 HIV 阳性患者进行异烟肼预防性治疗的策略。

IF 3.4 3区医学 Q2 INFECTIOUS DISEASES

International Journal of Tuberculosis and Lung Disease Pub Date : 2024-07-01 DOI:10.5588/ijtld.23.0303

A Savinkina, W Muyindike, J A Hahn, N I Emenyonu, R Fatch, C Ngabirano, J Adong, K R Jacobson, B P Linas

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引用次数: 0

摘要

背景世界卫生组织（WHO）出于肝毒性考虑指导经常饮酒者推迟接受异烟肼预防性治疗（IPT），这可能会将许多在这些情况下具有高结核病风险的艾滋病病毒感染者（PLWH）排除在外。方法我们利用 "饮酒者接触结核病预防疗法（ADEPTT）"研究的数据，建立了一个关于结核病潜伏感染、异烟肼预防疗法（IPT，TPT 的一种）和结核病的马尔可夫模型。我们模拟了几种治疗方案，包括无 IPT 方案、在治疗期间进行肝酶监测（AST/ALT）的 IPT 方案以及使用结核菌素皮试（TST）进行预筛的 IPT 方案。结论对于在结核病高负担环境中报告酗酒的 PLWH，应提供 IPT，最好定期监测 AST/ALT。然而，即使无法进行定期监测，在几乎所有的模型方案中，综合治疗仍优于无综合治疗。

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Strategies for isoniazid preventive therapy in HIV-positive patients who consume alcohol.

BACKGROUNDWHO guidance to defer isoniazid preventive therapy (IPT) among those with regular alcohol use because of hepatotoxicity concerns may exclude many people living with HIV (PLWH) at high TB risk in these settings.OBJECTIVETo evaluate hepatotoxicity during TB preventive therapy (TPT) in PLWH who report alcohol use in Uganda over 10 years.METHODSWe developed a Markov model of latent TB infection, isoniazid preventive therapy (IPT - a type of TPT), and TB disease using data from the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) study. We modeled several treatment scenarios, including no IPT, IPT with liver enzyme monitoring (AST/ALT) during treatment, and IPT with pre-screening using the tuberculin skin test (TST).RESULTSThe no IPT scenario had 230 TB deaths/100,000 population over 10 years, which is more than that seen in any IPT scenario. IPT, even with no monitoring, was preferred over no IPT when population TB disease incidence was >50 in 100,000.CONCLUSIONSFor PLWH who report alcohol use in high TB burden settings, IPT should be offered, ideally with regular AST/ALT monitoring. However, even if regular monitoring is not possible, IPT is still preferable to no IPT in almost every modeled scenario..

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来源期刊

International Journal of Tuberculosis and Lung Disease 医学-传染病学

CiteScore

4.90

自引率

20.00%

发文量

266

审稿时长

2 months

期刊介绍： The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.