Outcomes of isoniazid prophylaxis among HIV-infected children attending routine HIV care in Kenya

SETTING: Three human immunodeficiency virus (HIV) care clinics in Eastern Province, Kenya. OBJECTIVES: To establish rates of treatment completion, loss to follow-up, adverse drug reactions, tuberculosis (TB) disease and mortality among 606 HIV-infected children during 6 months of isoniazid preventive therapy (IPT). DESIGN: Retrospective record review. RESULTS: Of 606 HIV-infected children started on IPT, 556 (91.7%) successfully completed treatment, while 20 (3.3%) completed with interruptions. Cumulatively, 30 children (4.9%) did not complete IPT: 4 (0.7%) were lost to follow-up, 4 (0.7%) discontinued because of treatment interruptions, 2 (0.3%) developed adverse drug reactions, 1 developed a chronic cough, 1 was transferred to a non-IPT facility and 18 (3%) developed TB, including 2 who eventually died. TB disease was diagnosed in a median of 3 weeks (interquartile range [IQR] 2-16) post-IPT initiation. The median CD4 cell count for those aged 1-4 years who developed TB disease was 1023 cells/mm(3) (IQR 375-1432), while for those aged 5-14 years it was 149 cells/mm(3) (IQR 16-332). Isoniazid resistance was not detected in the four culture-confirmed TB cases. CONCLUSION: The high treatment completion, low loss to follow-up rate and few adverse drug reactions affirm the feasibility of IPT provision to children in HIV care clinics.