HIV: the benefits of prophylaxis of tuberculosis are confirmed

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Abidjan ANRS TEMPRANO
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Long-term follow-up in the ANRS TEMPRANO trial confirms that tuberculosis chemoprophylaxis in HIV-infected people is more than ever relevant in resource-limited countries. This prophylactic use of drugs reduces mortality, even among people taking antiretroviral treatment who have a high CD4+ T cell count. ANRS TEMPRANO was conducted by researchers of the Ivory Coast ANRS site, which comprises teams from Inserm (U1219, University of Bordeaux), the Infectious and Tropical Diseases Department of the Treichville University Hospital, and 8 other infection treatment centers in Abidjan. The results of this trial will be published in the 9 October 2017 issue of The Lancet Global Health and should encourage countries where the burden of tuberculosis is heavy to apply the relevant WHO recommendations.

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Tuberculosis is the leading cause of death among HIV-infected people in sub-Saharan Africa. In the 1990s, several studies showed that HIV-infected people who take the antibiotic isoniazid, for 6 to 12 months, are at lower risk of developing tuberculosis. On the basis of these studies, since 1993 the WHO has recommended that people living with HIV in countries where tuberculosis is rife should take isoniazid for 6 months. However, this recommendation has been little applied because it was deemed obsolete following the advent of antiretrovirals that restore immunity and hence lower the risk of tuberculosis. ANRS TEMPRANO has reassessed the benefits of isoniazid prophylaxis in the era of early antiretroviral treatment.

ANRS TEMPRANO was coordinated by Dr Xavier Anglaret and Professor Serge Eholie and conducted by researchers from the Ivory Coast ANRS site, which comprises teams from Inserm (U1219, University of Bordeaux), the Infectious and Tropical Diseases Department of the Treichville University Hospital, and 8 other HIV care centers in Abidjan. Sponsored and mainly funded by the ANRS, ANRS TEMPRANO, which was conducted between 2008 and 2015, showed that 6-month isoniazid prophylaxis for tuberculosis and early antiretroviral treatment both reduced the risk of severe morbidity in the first two years of follow-up. Published in The New England Journal of Medicine in 2015, these results greatly contributed to the formulation of WHO treatment recommendations. ANRS TEMPRANO participants were then followed up for an average of 4.5 years, and the findings are now published in the 9 October 2017 issue of The Lancet Global Health. This long-term follow-up shows that tuberculosis chemoprophylaxis reduces not only severe morbidity, but also mortality, and that this benefit, which is independent of and complementary to that of antiretroviral treatment, lasts at least 6 years after administration.

Professor François Dabis, the Director of the ANRS, notes that "We now have irrefutable evidence of the value of tuberculosis chemoprophylaxis in HIV-infected people in resource-limited countries in the era of antiretrovirals, even when these are initiated very early. The WHO recommendations should more than ever be applied."

Sources: Badje A, Moh R, Gabillard D, et al. Effect of isoniazid preventive therapy on risk of death in west African HIV-infected adults with high CD4 count: long-term follow up of the Temprano ANRS 12136 trial. Lancet Glob Health 2017; 5: e1080–89
Anani Badje1,2, Raoul Moh1,2,3, Delphine Gabillard1,2, Calixte Guéhi1,4, Mathieu Kabran2,5, Jean-Baptiste Ntakpé1, 2, Jérôme Le Carrou1,2, Gérard M. Kouame1,2, Eric Ouattara1,2, Eugène Messou1,2,3,6, Amani Anzian2,6, Albert Minga1,2,7, Joachim Gnokoro6, Patrice Gouesse6, Arlette Emieme2,5, Thomas-d’Aquin Toni2,5, 9, Cyprien Rabe3, Baba Sidibé3 , Gustave Nzunetu3, Lambert Dohoun2,7, Abo Yao2,7, Synali Kamagate7, Solange Amon8, Amadou-Barenson Kouame8, Aboli Koua8, Emmanuel Kouamé8, Marcelle Daligou9, Denise Hawerlander9, Simplice Ackoundzé9, Serge Koule4, Jonas Séri4, Alex Ani4, Fassery Dembélé4, Fatoumata Koné4, Mykayila Oyebi10, Nathalie Mbakop10, Oyewole Makaila10, Carolle Babatunde11, Nathaniel Babatunde11, Gisèle Bleoué11, Mireille Tchoutedjem11, Alain-Claude Kouadio12, Ghislaine Sena12, Sahinou-Yediga Yededji12, Sophie Karcher1,2 , Christine Rouzioux13, Abo Kouame14, Rodrigue Assi15, Alima Bakayoko15, Serge K. Domoua15, Nina Deschamps2, Kakou Aka2,3, Thérèse N’Dri-Yoman2,16, Roger Salamon1,2, Valérie Journot1, Hughes Ahibo2,5, Timothée Ouassa2,5, Hervé Menan2,5, André Inwoley2,5, Christine Danel1,2, Serge P. Eholié1,2,3, Xavier Anglaret1,2 1 Inserm 1219, University of Bordeaux, France, 2 Programme PAC-CI, ANRS research center, Abidjan, Côte d’Ivoire, 3 Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire, 4 Unité de Soins Ambulatoire et de Conseil (USAC), Treichville, Abidjan, Côte d’Ivoire, 5 Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), CHU de Treichville, Abidjan, Côte d’Ivoire, 6 Centre de Prise en Charge de Recherche et de Formation (CePReF), Yopougon, Abidjan, Côte d’Ivoire, 7 Centre Médical de Suivi des Donneurs de Sang (CMSDS), Treichville, Abidjan, Côte d’Ivoire, 8 Hôpital Général d’Abobo Nord, Abobo, Abidjan, Côte d’Ivoire, 9 Centre Intégré de Recherches Biocliniques d’Abidjan (CIRBA), Treichville, Abidjan, Côte d’Ivoire, 10 Formation Sanitaire Urbaine Communautaire (FSU Com) d’Anonkoua Kouté, Abobo, Abidjan, Côte d’Ivoire, 11 Hôpital El Rapha, Abobo, Abidjan, Côte d’Ivoire, 12 Centre ‘La Pierre Angulaire’, Treichville, Abidjan, Côte d’Ivoire, 13 Laboratoire de virologie, CHU Necker, Paris, France, 14 Programme National de Lutte contre le SIDA, Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d’Ivoire, 15 Service de Pneumologie, CHU de Treichville, Abidjan, Côte d’Ivoire, 16 Service de Gastro-entéro-hépatologie, CHU de Yopougon, Abidjan, Côte d’Ivoire