PMID- 37575717
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230815
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 7
DP  - 2023 Jul
TI  - Adverse Events of Latent Tuberculosis Treatment With Isoniazid in People Living 
      With HIV: A Case-Control Study in a Resource-Rich Setting.
PG  - e41647
LID - 10.7759/cureus.41647 [doi]
LID - e41647
AB  - Introduction Multiple risk factors, such as human immunodeficiency virus (HIV) 
      infection and immunosuppressive therapies, increase the odds of latent 
      tuberculosis infection (LTBI) reactivation and progression to active 
      tuberculosis. A six-to-nine-month preventive treatment with isoniazid (INH) 
      decreases the risk of LTBI reactivation, but its effectiveness can be limited by 
      its long duration and adverse events (AEs), including liver toxicity. Due to 
      comorbidities and polypharmacy, people living with HIV (PLHIV) may be at 
      increased risk of INH-associated AEs. Our study aimed to assess the prevalence of 
      AEs among patients receiving INH treatment for LTBI, to identify risk factors for 
      their occurrence, and to evaluate whether PLHIV have higher odds of developing 
      INH-associated AEs. Methods We conducted a single-center retrospective 
      case-control study, including 130 outpatients with LTBI treated with INH between 
      July 2019 and March 2022. Participants who developed AE (cases) were compared to 
      controls, and a subgroup of PLHIV was compared to HIV-negative participants. 
      Demographics, socioeconomic variables, comorbidities, and clinical variables were 
      compared between study groups. Patient data were obtained from institutional 
      electronic medical records, and outcomes were measured at regularly scheduled 
      appointments. Results We included 130 participants, of which 54 were PLHIV. The 
      PLHIV subgroup was significantly younger (p = 0.01) and demonstrated 
      significantly higher prevalences of chronic liver disease, previous viral 
      hepatitis, daily alcohol consumption, and intravenous drug use (IDU). One-third 
      of the participants had an AE (45 cases, 34.6%), with liver toxicity being the 
      most common (22.3%). Participants who developed AEs were significantly older (p = 
      0.030) and had a higher prevalence of economic hardship (p = 0.037), as well as 
      higher scores of the Charlson comorbidity index (p = 0.002) than the controls. 
      INH withdrawal occurred in 17 participants (13.1%) and was mainly associated with 
      liver toxicity (p < 0.01) and gastrointestinal symptoms (p = 0.022). In the 
      adjusted effect model, an age >/= 65 years, economic hardship, and excessive 
      alcohol consumption were significantly associated with higher odds of AEs, while 
      HIV infection decreased the odds by 68.4% (p = 0.033). Conclusions In our study, 
      INH-associated AEs were common, with liver toxicity being the most frequent. 
      Older age, economic hardship, and excessive alcohol consumption increased the 
      odds of INH-associated AEs, while PLHIV had lower odds of developing 
      INH-associated AEs, even when adjusting for other variables in the multivariate 
      analysis. Further studies should be conducted to assess if these results are 
      replicable in a larger population and in different settings.
CI  - Copyright (c) 2023, Carlos Silveira Machado et al.
FAU - Carlos Silveira Machado, Antonio
AU  - Carlos Silveira Machado A
AD  - Medicine, Faculty of Medicine - University of Porto, Porto, PRT.
FAU - Figueiredo, Cristovao
AU  - Figueiredo C
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
FAU - Teixeira, Tiago
AU  - Teixeira T
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
FAU - Azevedo, Carlos
AU  - Azevedo C
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
FAU - Fragoso, Joana
AU  - Fragoso J
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
FAU - Nunes, Sofia
AU  - Nunes S
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
FAU - Coutinho, Daniel
AU  - Coutinho D
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
FAU - Malheiro, Luis
AU  - Malheiro L
AD  - Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de 
      Gaia, PRT.
AD  - Medicine, Porto Academic and Clinical Centre, Porto, PRT.
AD  - Medicine, Faculty of Medicine - University of Porto, Porto, PRT.
LA  - eng
PT  - Journal Article
DEP - 20230710
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10412740
OTO - NOTNLM
OT  - drug-related adverse reactions
OT  - drug-related side effects
OT  - hiv
OT  - immunomodulation
OT  - isoniazid
OT  - latent tuberculosis
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/08/14 06:42
MHDA- 2023/08/14 06:43
PMCR- 2023/07/10
CRDT- 2023/08/14 04:33
PHST- 2023/07/09 00:00 [accepted]
PHST- 2023/08/14 06:43 [medline]
PHST- 2023/08/14 06:42 [pubmed]
PHST- 2023/08/14 04:33 [entrez]
PHST- 2023/07/10 00:00 [pmc-release]
AID - 10.7759/cureus.41647 [doi]
PST - epublish
SO  - Cureus. 2023 Jul 10;15(7):e41647. doi: 10.7759/cureus.41647. eCollection 2023 
      Jul.