Preventive therapy for tuberculosis in HIV infection: the promise and the reality

AIDS. 1995 Jul;9(7):665-73. doi: 10.1097/00002030-199507000-00001.

Abstract

PIP: An increasing incidence of tuberculosis has been recorded in areas where both human immunodeficiency virus (HIV) and Mycobacterium tuberculosis are prevalent. 98% of HIV-associated tuberculosis cases occur in developing countries, most notably sub-Saharan Africa. This trend has led to the consideration of tuberculosis prevention therapy for HIV-infected patients. The efficacy of isoniazid for this purpose has been demonstrated in numerous clinical trials, but its application has been limited by concerns about hepatotoxicity, non-adherence, drug resistance, and costs. Recommended is the approach adopted in the US of providing a six-month course of isoniazid to those with a positive tuberculin skin test reaction and epidemiologic risk factors; for those already infected with HIV, 12 months of treatment is suggested. Rifampicin preventive therapy is recommended for those infected by isoniazid-resistant bacilli. Needed are studies to assess operational feasibility, cost-benefits, the use of life-long isoniazid preventive therapy in areas of high tuberculosis transmission, and alternative regimens such as short-course multidrug treatment.

Publication types

  • Editorial
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control*
  • Adult
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / therapeutic use*
  • Chemical and Drug Induced Liver Injury / etiology
  • Cost-Benefit Analysis
  • Humans
  • Isoniazid / administration & dosage
  • Isoniazid / therapeutic use*
  • Patient Compliance
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Tuberculosis, Multidrug-Resistant / etiology
  • Tuberculosis, Multidrug-Resistant / prevention & control
  • Tuberculosis, Pulmonary / etiology
  • Tuberculosis, Pulmonary / prevention & control*

Substances

  • Antitubercular Agents
  • Isoniazid