Skip to main content Skip to main navigation menu Skip to site footer

Effect of isoniazid preventive therapy on pulmonary tuberculosis activity in people living with HIV/AIDS at Wangaya hospital in Denpasar, Bali, Indonesia: a prospective cohort study


Background: Isoniazid Preventive Therapy (IPT) can reduce the Active Pulmonary Tuberculosis (APT) in People living with HIV/AIDS (PLWHA).  IPT is recommended by the World Health Organization (WHO). It has not been implemented routinely in all countries.

Aim: To evaluate whether IPT in PLWHA reduces the APT at Wangaya Hospital, in Denpasar, Bali, Indonesia.

Methods: A prospective cohort study was conducted during October 2014 until November 2016. A total of 244 PLWHA were included in this study. The first group were 122 participants received antiretroviral therapy (ART) and IPT and 122 participants received only ART (second group). Cox regression analysis was employed to calculate effects in both groups and to identify predictor factors for active tuberculosis. The statistical analysis performed with cox proportional hazard model.

Results: There were 137 (56.1%) males and 107 (43.9%) females. Incidence of APT in the IPT group was 1.09 per 100 person years and non IPT groups was 12.57 per 100 person years. Incidence of APT in the non IPT groups was significantly higher than in the IPT groups with crude hazard ratio (cHR) of 12.59 (95% CI: 2.70-53.43). After variables adjustment for age, sex and CD4 count, the incidence of APT in the non IPT group were found with adjustment hazard ratio (aHR) of 10.26 (95% CI: 2.15-48.99).

Conclusion:  The incidence of APT was significantly higher in the non IPT group than in the IPT group.


  1. Assebe LF, Reda HL, Wubeneh AD, Lerebo WT, Lambert SM. The effect of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected clients under pre-ART care, Jimma, Ethiopia : a retrospective cohort study. BMC Public Health. 2015;15:1–9.
  2. Implementing the WHO Stop TB Strategy: a handbook for national tuberculo-sis control programmes. geneva, World Health Organization, 2008 (WHO/HTm/TB/2008.401).
  3. WHO Global Report 2013. available from: 10665/91355
  4. Sibanda T, Tedla Z, Nyirenda S, Agizew T, Marape M, Miranda AG, et al. Anti-tuberculosis treatment outcomes in HIV-infected adults exposed to isoniazid preventive therapy in Botswana. Int J Tuberc Lung Dis. 2013;17(2):178–85.
  5. Grinsven JV, Choun K, Chim B, Thai S, Lorent N, Lynen L. Implementation of Isoniazid preventive therapy in an HIV clinic in Cambodia: high rates of discontinuation when combined with antiretroviral therapy. Trop Med Int Health. 2015;20:11823-31.
  6. Mcilleron H, Meintjes G, Burman WJ, Maartens G. Complications of Antiretroviral therapy in patients with tuberculosis : drug interactions, toxicity, and immune reconstitution inflammatory syndrome. J Infect Dis. 2007;196:S63–S75.
  7. Day JH, Charalambous S, Fielding KL, Hayes RJ, Churchyard GJ, Grant AD. Screening for tuberculosis prior to isoniazid preventive therapy among HIV-infected gold miners in South Africa. Int J Tuberc Lung Dis 2006;10:523–9.
  8. World Health Organization. Interim policy on collaborative TB/HIV activities. Geneva: WHO Press; 2004. Report No. WHO/HTM/TB/2004.330, WHO/HTM/HIV/2004.1. 2004
  9. WHO/IUATLD. Tuberculosis preventive therapy in HIV-infected individuals. A joint statement of the WHO Tuberculosis Programme and the Global Programme on AIDS, and the International Union Against Tuberculosis and Lung Disease (IUATLD). Wkly Epidemiol Rec 1993; 68:361–4.
  10. WHO/UNAIDS. WHO and UNAIDS policy statement on preventive therapy against tuberculosis in people living with HIV. Wkly Epidemiol Rec 1999; 74:385–400.
  11. Getahun H, Granich R, Sculier D, Gunneberg C, Blanc L, Nunn P, et al. Implementation of isoniazid preventive therapy for people living with HIV worldwide : barriers and solutions. AIDS 2010;24:S57–S65.
  12. Lwanga SK, Lemeshow S. Sample size determination in health studies, A practical manual. World Health Organization. 1991:1-3
  13. Yirdaw KD, Jerene D, Gashu Z, Edginton ME, Kumar AM, Letamo Y, et al. Beneficial effect of isoniazid preventive therapy and antiretroviral therapy on the incidence of tuberculosis in people living with HIV in Ethiopia. PloS One 2014;9:1–8.
  14. Edessa D, Woldeyes T, Shibeshi W. Comparison of effects of isoniazid plus ART and ART only regimen on the incidence of tuberculosis and HIV progression in HIV positive patients: a retrospective cohort study at two hospitals in Addis Ababa. Int J Basic Clin Pharmacol 2014;3:54–62.
  15. Quigley M, Mwinga A, Hosp M, Lisse I, Fuchs D, Porter JDH, et al. Long-term effect of preventive therapy for tuberculosis in a cohort of HIV-infected Zambian adults. AIDS 2001;15:215–22.
  16. Hermans SM, Grant AD, Chihota V, Lewis JJ, Vynnycky E, Churchyard GJ, et al. The timing of tuberculosis after isoniazid preventive therapy among gold miners in South Africa : a prospective cohort study. BMC Med 2016;14:1–11.
  17. Hawken MP, Meme HK, Elliott LC, Chakaya JM, Morris JS, Githui WA, et al. Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: results of a randomized controlled trial. AIDS 1997;11:875–82.
  18. Khawcharoenporn T, Apisarnthanarak A, Manosuthi W, Sungkanuparph S, Mundy LM. Isoniazid preventive therapy and 4-year incidence of pulmonary tuberculosis among HIV-infected Thai patients. Int J Tuberc Lung Dis 2012;16:336–41.
  19. Ayele HT, Mourik MSM Van, Debray TPA, Marc J, Bonten M. Isoniazid prophylactic therapy for the prevention of tuberculosis in HIV infected adults : a systematic review and meta- analysis of randomized trials. Plos One. 2015;10:1–16.
  20. Golub JE, Saraceni V, Cavalcante, Pacheco AG, Moulton LH, King BS, et al. The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS 2007;21:1441–8.
  21. Jerene D, Abebe W, Taye K, Suarez PG, Feleke Y, Hallström I, et al. Tuberculosis along the continuum of HIV care in a cohort of adolescents living with HIV in Ethiopia. Int J Tuberc Lung Dis 2017;21:32–7.
  22. Molaeipoor L, Poorolajal J, Mohraz M, Esmailnasab N. Predictors of tuberculosis and human immunodeficiency virus co-infection : a case-control study. Epidemiol Heal 2014;36:1–6.
  23. Delogu G, Sali M, Fadda G. The biology of Mycobacterium tuberculosis infection. Nediterr J Hematol Infect Dis 2013;5:1-8

How to Cite

Suryana, K., Suharsono, H., Antara, J., & Rai, I. B. N. (2020). Effect of isoniazid preventive therapy on pulmonary tuberculosis activity in people living with HIV/AIDS at Wangaya hospital in Denpasar, Bali, Indonesia: a prospective cohort study. Bali Medical Journal, 9(1), 219–223.




Search Panel