Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials

AIDS. 1999 Mar 11;13(4):501-7. doi: 10.1097/00002030-199903110-00009.


Objectives: To evaluate the efficacy of isoniazid for the prevention of tuberculosis in tuberculin skin test-positive and negative individuals with HIV infection.

Design: Meta-analysis of randomized controlled trials.

Setting: Seven trials from Mexico, Haiti, the United States, Zambia, Uganda and Kenya.

Patients: Individuals free from tuberculosis, 2367 persons in the intervention and 2162 in the control groups.

Intervention: Comparison of isoniazid with placebo or no prophylaxis.

Methods: A systematic search of the literature was carried out from 1985 to October 1997 for randomized controlled trials of isoniazid prophylaxis in HIV-infected persons. Two reviewers evaluated the relevance of each candidate study and the validity of eligible trials. Studies were pooled using a random effect model, conducting secondary analyses for tuberculin skin test-positive and negative persons.

Results: Mean follow-up in trials varied between 0.4 and 3.2 years. Pooling all seven trials, a risk ratio was found for persons treated with isoniazid for developing tuberculosis of 0.58 [95% confidence interval (CI), 0.43-0.80] and 0.94 (95% CI, 0.83-1.07) for death. In groups of tuberculin skin test-positive and negative persons, the risk ratio of tuberculosis was 0.40 (95% CI, 0.24-0.65) and 0.84 (95% CI, 0.54-1.30), respectively, and the difference in the effectiveness of isoniazid versus placebo between these groups was statistically significant (P = 0.03, for the difference of summary estimates). Consistency of results was found across trials (P > 0.10, heterogeneity value) for all comparisons.

Conclusions: Prophylaxis with isoniazid reduces the risk of tuberculosis in persons with HIV infection. The effect is restricted to tuberculin skin test-positive persons.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / mortality
  • AIDS-Related Opportunistic Infections / prevention & control*
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / adverse effects
  • Antitubercular Agents / pharmacology*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Isoniazid / administration & dosage
  • Isoniazid / adverse effects
  • Isoniazid / pharmacology*
  • Meta-Analysis as Topic
  • Tuberculosis / epidemiology
  • Tuberculosis / mortality
  • Tuberculosis / prevention & control*


  • Antitubercular Agents
  • Isoniazid