Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations

Proc Natl Acad Sci U S A. 2006 May 2;103(18):7042-7. doi: 10.1073/pnas.0600349103. Epub 2006 Apr 21.


In sub-Saharan Africa, where the emergence of HIV has caused dramatic increases in tuberculosis (TB) case notifications, new strategies for TB control are necessary. Isoniazid preventive therapy (IPT) for HIV-TB coinfected individuals reduces the reactivation of latent Mycobacterium tuberculosis infections and is being evaluated as a potential community-wide strategy for improving TB control. We developed a mathematical model of TB/HIV coepidemics to examine the impact of community-wide implementation of IPT for TB-HIV coinfected individuals on the dynamics of drug-sensitive and -resistant TB epidemics. We found that community-wide IPT will reduce the incidence of TB in the short-term but may also speed the emergence of drug-resistant TB. We conclude that community-wide IPT in areas of emerging HIV and drug-resistant TB should be coupled with diagnostic and treatment policies designed to identify and effectively treat the increasing proportion of patients with drug-resistant TB.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections* / drug therapy
  • AIDS-Related Opportunistic Infections* / epidemiology
  • AIDS-Related Opportunistic Infections* / prevention & control
  • Africa South of the Sahara / epidemiology
  • Antitubercular Agents / therapeutic use*
  • Comorbidity
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • Humans
  • Isoniazid / therapeutic use*
  • Models, Theoretical
  • Tuberculosis, Multidrug-Resistant* / drug therapy
  • Tuberculosis, Multidrug-Resistant* / epidemiology
  • Tuberculosis, Multidrug-Resistant* / etiology
  • Tuberculosis, Multidrug-Resistant* / prevention & control


  • Antitubercular Agents
  • Isoniazid