Providing IPT to people living with HIV does not increase the risk

Providing IPT to people living with HIV does not increase the risk
of developing INH-resistant TB. Therefore, concerns regarding the
development of INH resistance should not be a barrier to providing IPT.
Strong recommendation, moderate quality of evidence
One of the reasons commonly cited for not offering
IPT to people living with HIV is the fear of developing
drug-resistant TB. The Guidelines Group reviewed the
evidence on the provision of IPT and drug-resistant
TB, which was presented after GRADE assessment of
the evidence (Annex 10). This included eight studies
and the results of a meta-analysis which concluded
that INH resistance is not significantly associated with
the provision of IPT.[38] The GRADE assessment of
the evidence examined the relative risk of developing
INH-resistant TB among all of those receiving isoniazid
and found no statistically significant increased risk of
resistance (RR 95% CI= 1.87 [0.65–5.38]). In addition,
the results of a study that was under publication and
showed no risk of development of drug resistance
after provision of IPT to gold miners were also
presented and discussed.[39] The Guidelines Group
also noted that regular TB screening for those taking
IPT will help identify those who could develop TB as
early as possible. This early identification will allow for
prompt diagnosis and treatment, which should also
help to prevent the development of drug-resistant TB.
The Guidelines Group noted that in settings with high
INH resistance, fewer patients are likely to benefit
from IPT, and the decision to provide access to IPT
for people living with HIV should thus be based on
the local context. Programmes implementing IPT are
encouraged to introduce international and national TB
drug-resistance surveillance systems that also include
HIV testing as an integral component.