Isoniazid Preventive Therapy in HIV-Infected Pregnant and Postpartum Women.
AIDS-Related Opportunistic Infections
/ prevention & control
Adolescent
Adult
Antitubercular Agents
/ adverse effects
Double-Blind Method
Female
HIV Infections
/ drug therapy
Humans
Infant
Infant Mortality
Infant, Newborn
Infant, Very Low Birth Weight
Isoniazid
/ adverse effects
Liver Function Tests
Postpartum Period
Pregnancy
Pregnancy Complications, Infectious
/ drug therapy
Pregnancy Outcome
Premature Birth
/ epidemiology
Prospective Studies
Tuberculosis
/ prevention & control
Young Adult
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
03 10 2019
03 10 2019
Historique:
entrez:
3
10
2019
pubmed:
3
10
2019
medline:
24
10
2019
Statut:
ppublish
Résumé
The safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown. In this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years. A total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], -4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, -0.39; 95% CI, -1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, -0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9). The risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, NCT01494038.).
Sections du résumé
BACKGROUND
The safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown.
METHODS
In this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years.
RESULTS
A total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], -4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, -0.39; 95% CI, -1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, -0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9).
CONCLUSIONS
The risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, NCT01494038.).
Identifiants
pubmed: 31577875
doi: 10.1056/NEJMoa1813060
pmc: PMC7051859
mid: NIHMS1553134
doi:
Substances chimiques
Antitubercular Agents
0
Isoniazid
V83O1VOZ8L
Banques de données
ClinicalTrials.gov
['NCT01494038']
Types de publication
Equivalence Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1333-1346Subventions
Organisme : NIAID NIH HHS
ID : UM1 AI068632
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI069453
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068616
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069521
Pays : United States
Organisme : NIH HHS
ID : Overall support for the International Maternal Pe
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI069436
Pays : United States
Organisme : NICHD NIH HHS
ID : HHSN275201800001I
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI068632
Pays : United States
Organisme : NIMH NIH HHS
ID : R21 MH083308
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI069521
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI069465
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI106716
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069436
Pays : United States
Investigateurs
Haroon Saloojee
(H)
Wafaa El-Sadr
(W)
David Harrington
(D)
Jonathan B Levine
(JB)
Carl Jacobus Lombard
(CJ)
Mary Faith Marshall
(MF)
Lucky Mokgatlhe
(L)
Paula Munderi
(P)
Andrew Nunn
(A)
Jerome Amir Singh
(JA)
Betty Kwagala
(B)
Carl Jacobus Lombard
(CJ)
Alwyn Mwinga
(A)
Papa Salif Sow
(PS)
Catherine Hill
(C)
Jerrold J Ellner
(JJ)
Grace John-Stewart
(G)
Steven Joffe
(S)
Barbara E Murray
(BE)
Merlin L Robb
(ML)
Enid Kabugho
(E)
Deo Wabwire
(D)
Hellen Kaganzi
(H)
Joel Maena
(J)
Hajira Kataike
(H)
Patricia Mandima
(P)
Emmie Marote
(E)
Mercy Mutambanengwe
(M)
Teacler Nematadzira
(T)
Suzen Maonera
(S)
Vongai Chanaiwa
(V)
Tapiwa Mbengeranwa
(T)
Sukunena Maturure
(S)
Tsungai Mhembere
(T)
Mandisa Nyati
(M)
Nasreen Abrahams
(N)
Haseena Cassim
(H)
Ruth Mathiba
(R)
Joan Coetzee
(J)
Jeanne Louw
(J)
Marlize Smuts
(M)
Lindie Rossouw
(L)
Magdel Rossouw
(M)
Celeste de Vaal
(C)
Sharon Mbaba
(S)
Karen du Preez
(K)
Frieda Verheye-Dua
(F)
Aisa Shao
(A)
Boniface Njau
(B)
Philoteus Sakasaka
(P)
Seleman Semvua
(S)
Tebogo J Kakhu
(TJ)
Thuto Ralegoreng
(T)
Ayotunde Omoz-Oarhe
(A)
Unoda Chakalisa
(U)
Nishi Suryavanshi
(N)
Sandesh Patil
(S)
Neetal Nevrekar
(N)
Renu Bharadwaj
(R)
Vandana Kulkarni
(V)
Fuanglada Tongprasert
(F)
Tavitiya Sudjaritruk
(T)
Chintana Khamrong
(C)
Prapaporn Janjing
(P)
Marie Flore Pierre
(MF)
Maria Linda Aristhomene
(ML)
Dominique Lespinasse
(D)
Emelyne Dumont
(E)
Rebecca LeBlanc
(R)
Amy James Loftis
(AJ)
Soyeon Kim
(S)
David Shapiro
(D)
Camlin Tierney
(C)
Vivian Rexroad
(V)
Renee Browning
(R)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Massachusetts Medical Society.
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