Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virology. May 12, 2015; 4(2): 105-112
Published online May 12, 2015. doi: 10.5501/wjv.v4.i2.105
Debunking the myths perpetuating low implementation of isoniazid preventive therapy amongst human immunodeficiency virus-infected persons
Christopher Akolo, Florence Bada, Evaezi Okpokoro, Ogochukwu Nwanne, Sharon Iziduh, Eno Usoroh, Taofeekat Ali, Vivian Ibeziako, Olanrewaju Oladimeji, Michael Odo
Christopher Akolo, Population Services International, Washington, DC 20036, United States
Florence Bada, Evaezi Okpokoro, Ogochukwu Nwanne, Sharon Iziduh, Eno Usoroh, Taofeekat Ali, Vivian Ibeziako, Institute of Human Virology, Nigeria (IHVN), Plot 252, PO Box 9396, Abuja, Nigeria
Olanrewaju Oladimeji, Zankli Medical Center, Plot 1021, PO Box 7745, Abuja, Nigeria
Olanrewaju Oladimeji, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, United Kingdom
Michael Odo, Family Health International (FHI360), Plot 1073, Garki, Area 3| P.M.B. 44, Abuja, Nigeria
Author contributions: Akolo C and Bada F were both responsible for the conceptualization of this article; Akolo C, Bada F, Okpokoro E, Iziduh S, Usoroh E, Nwanne O, Ali T, Ibeziako V, Oladimeji O and Odo M all contributed equally to the writing, editing and final approval of this work.
Conflict-of-interest: The authors have no conflict of interest related to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Christopher Akolo, MBBS, MSc, FWACP, Senior Technical Advisor HIV/TB, Population Services International, 1120 19th Street, N.W. Ste. 600, Washington, DC 20036, United States.
Telephone: +1-240-5810853
Received: October 23, 2014
Peer-review started: October 23, 2014
First decision: November 14, 2014
Revised: December 4, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 12, 2015

Isoniazid preventive therapy (IPT) is the administration of isoniazid (INH) to people with latent tuberculosis (TB) infection (LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunodeficiency virus (HIV)-infected persons who do not have active TB, IPT is poorly implemented globally due to misconceptions shared by healthcare providers and policy makers. However, amongst HIV-infected patients especially those living in resource-limited settings with a high burden of TB, available evidence speaks for IPT: Among HIV-infected persons, active TB- the major contraindication to IPT, can be excluded with symptom screening; chest X-ray and tuberculin skin testing are unreliable and often lead to logistic delays resulting in increased numbers of people with LTBI progressing to active TB; the use of IPT has not been found to increase the risk of the development of INH mono-resistance; IPT is cost-effective and cheaper than the cost of treating cases of active TB that would develop without IPT; ART and IPT have an additive effect on the prevention of TB, and both are safe and beneficial even in children. In order to sustain the recorded gains from ART scale-up and to further reduce TB-related morbidity and mortality, more efforts are needed to scale-up IPT implementation globally.

Keywords: Human immunodeficiency virus, Isoniazid preventive therapy, Tuberculosis, Chemoprophylaxis

Core tip: To better inform healthcare providers, policy makers and human immunodeficiency virus-infected persons about isoniazid preventive therapy (IPT), this article summarizes the existing evidence in support of IPT including recommendations for scale-up of implementation globally.