引言多重风险因素,如人类免疫缺陷病毒(HIV)感染和免疫抑制疗法,增加潜伏性结核感染(LTBI)再激活和进展为活动性结核的几率。异烟肼(INH)6至9个月的预防性治疗可降低LTBI再激活的风险,但其有效性可能受到其持续时间长和不良事件(AE)的限制,包括肝脏毒性.由于合并症和多重用药,HIV感染者(PLHIV)发生INH相关AE的风险可能增加.我们的研究旨在评估接受INH治疗的LTBI患者中AE的患病率,为了确定它们发生的危险因素,并评估PLHIV是否有更高的发生INH相关不良事件的几率。方法采用单中心回顾性病例对照研究,包括2019年7月至2022年3月期间接受INH治疗的130名LTBI门诊患者。将发生AE(病例)的参与者与对照组进行比较,并将PLHIV亚组与HIV阴性参与者进行了比较.人口统计,社会经济变量,合并症,和临床变量在研究组之间进行比较.患者数据来自机构电子病历,并在定期预约时测量结果。结果我们包括130名参与者,其中54人是艾滋病毒感染者。PLHIV亚组显着年轻(p=0.01),并显示出慢性肝病的患病率显着升高,以前的病毒性肝炎,每日饮酒,静脉注射药物(IDU)。三分之一的参与者有AE(45例,34.6%),肝毒性是最常见的(22.3%)。出现不良事件的参与者年龄明显较大(p=0.030),经济困难发生率较高(p=0.037),以及Charlson合并症指数得分(p=0.002)高于对照组。17名参与者(13.1%)发生INH戒断,主要与肝毒性(p<0.01)和胃肠道症状(p=0.022)有关。在调整后的效果模型中,年龄≥65岁,经济困难,过量饮酒与较高的AE几率显着相关,而HIV感染的几率降低了68.4%(p=0.033)。结论在我们的研究中,INH相关的AE很常见,肝脏毒性是最常见的。年纪大了,经济困难,过量饮酒增加了异烟肼相关AE的几率,虽然PLHIV发生INH相关AE的几率较低,即使在多变量分析中调整其他变量时也是如此。应进行进一步的研究,以评估这些结果是否可在更大的人群和不同的环境中复制。
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.