Completion Rates and Hepatotoxicity of Isoniazid Preventive Therapy Among Children Living with HIV/AIDS: Findings and Implications in Northwestern Nigeria

The burden of childhood tuberculosis continues to remain unacceptably high in developing countries despite the preventability and curability of the disease. Tuberculosis and human immunodeficiency virus (HIV) often coexist and impact each other and thus form a highly lethal partnership. Consequently, measures such as isoniazid preventive therapy (IPT) that can prevent such coexistence is highly warranted. However, low uptake and completion rate, and hepatotoxicity threaten the beneficial effects of IPT. The study investigated the completion rate of a 6-month course of IPT among HIV/acquired immune deficiency syndrome-infected children on antiretroviral drugs and the predictors of hepatotoxicity of the IPT. The 4-year retrospective chart review revealed a less-than-adequate IPT completion rate of 56.9% (244/429) that was predicted by young age (≤10 years) and low socioeconomic status of the children. A grade 1 level elevation of alanine transaminase (47.5–95.0 U/L: mild hepatotoxicity) was also recorded among 18.0% (37/205) of the children and this was predicted by HIV clinical stage. The alanine transaminase levels of the remaining children (82.0%; 168/205) were within the normal range. Interventions designed to improve the IPT completion rate and periodic measurement of alanine transaminase for those with advanced HIV (HIV clinical stages 3 and 4) were recommended.