Short-course prophylaxis against tuberculosis in HIV-infected persons. A decision and cost-effectiveness analysis

Ann Intern Med. 1998 Nov 15;129(10):779-86. doi: 10.7326/0003-4819-129-10-199811150-00005.


Background: Isoniazid prophylaxis for 12 months effectively prevents tuberculosis in HIV-infected persons and may decrease the incidence of other HIV-related disease and mortality. Recent clinical trials have found that some short-course regimens also effectively prevent tuberculosis.

Objective: To compare the benefits, risks, and cost-effectiveness of isoniazid prophylaxis and short-course prophylaxis regimens.

Design: Decision and cost-effectiveness analysis.

Setting: United States.

Patients: Hypothetical patients who are HIV-infected and have CD4 counts of 200 cells/mm3 or less and positive results on tuberculin skin tests.

Interventions: Isoniazid prophylaxis lasting 12 months and six short-course prophylaxis regimens of isoniazid, rifampin, and pyrazinamide alone or in combination.

Measurements: 5-year survival rate, life expectancy, lifetime incidence of tuberculosis, and cost per quality-adjusted life-year saved.

Results: Compared with no prophylaxis, the 12-month isoniazid regimen increased 5-year survival rates by 9% and life expectancy by 8.7 months, decreased incidence of tuberculosis by 27%, and saved 4 medical care dollars for every 1 spent on prophylaxis. Regimens of isoniazid for 6 months, isoniazid and rifampin for 3 months, and rifampin and pyrazinamide for 2 months had similar results: 6.2- to 8.6-month increases in life expectancy, 19% to 26% reductions in incidence of tuberculosis, and 1 to 7 medical care dollars saved for every 1 spent on prophylaxis. A 3-month regimen of isoniazid, rifampin, and pyrazinamide resulted in fewer clinical benefits and was the only regimen tested that did not save medical care dollars.

Conclusions: Prophylaxis decreases the incidence of tuberculosis and increases life expectancy for HIV-infected patients. Some regimens save medical care dollars, and some short-course regimens have clinical and economic benefits similar to those of the 12-month isoniazid regimen. Short-course prophylaxis is a reasonable alternative to the 12-month isoniazid regimen.

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control*
  • Antibiotics, Antitubercular / administration & dosage
  • Antitubercular Agents / administration & dosage*
  • Antitubercular Agents / adverse effects
  • Antitubercular Agents / economics
  • Chemical and Drug Induced Liver Injury / etiology
  • Cost-Benefit Analysis
  • Decision Trees
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Humans
  • Isoniazid / administration & dosage*
  • Isoniazid / adverse effects
  • Isoniazid / economics
  • Pyrazinamide / administration & dosage
  • Quality-Adjusted Life Years
  • Rifampin / administration & dosage
  • Survival Rate
  • Tuberculosis / prevention & control*


  • Antibiotics, Antitubercular
  • Antitubercular Agents
  • Pyrazinamide
  • Isoniazid
  • Rifampin