Randomised trial of isoniazid versus rifampicin and pyrazinamide for prevention of tuberculosis in HIV-1 infection

Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV

“…Clinical trials have shown that IPT dramatically reduces the incidence of TB among people living with HIV. [28][29][30][31][32][33][34][35][36] A 2004 Cochrane Review found that IPT reduced the risk of TB by 33% overall and by 64% when targeted to people living with HIV who had a positive tuberculin skin test. 36 A recent retrospective study also showed that IPT significantly reduced the incidence of TB even among people living with HIV and receiving ART.…”

Risk Factors for tuberculosis among human immunodeficiency virus-infected persons. A case-control study in Belo Horizonte, Minas Gerais, Brazil (1985-1996)

“…The prognosis is often poor, albeit it depends on the immunosupression degree and to the response to antituberculosis drugs (Ackah et al 1995, Shafer et al 1996, Whalen et al 1997b). Recent studies confirmed the chemoprophylaxis value for tuberculosis protection among HIV-infected patients with PPD positive reaction (Whalen et al 1997a, Halsey et al 1998, Wilkinson et al 1998) and this could be the most important strategy for tuberculosis control in this population. Other strategies, as early diagnosis and treatment, and BCG vaccination are limited in HIV infection, because of atypical clinical presentations, diagnosis delay and lack of safety data about BCG vaccination in this population.…”

“…Among HIVinfected persons PPD reactivity (≥ 5 mm) is a well known risk factor (Selwyn et al 1989, Barnes & Barrows 1993, Ellner et al 1993, Nunn et al 1994, Toledo Jr et al 1994, and the chemoprophylaxis in these cases has a protection effect (Whalen et al 1997a, Halsey et al 1998, Wilkinson et al 1998. Highly active antiretroviral therapy (HAART) seems to have a protection effect also, as recent studies showed a low incidence of opportunistic infections, including tuberculosis, after HAART introduction (Borleffs et al 1998, Viciana et al 1998, Sparano et al 1999.…”

Tuberculosis Prevention

“…To date, the results of clinical trials have shown that all regimens involving isoniazid and rifampin or rifampin and pyrazinamide for 2 to 3 months yield inferior results to those of isoniazid alone for 6 months and are substantially worse than isoniazid alone for 12 months. [44][45][46] However, compliance is much better with shorter regimens, so under program conditions the effectiveness of the shorter regimens may in fact be equivalent to that of the longer isoniazid regimens.…”