People with HIV in developing countries are far more likely to contract tuberculosis than those without HIV. Although drugs to help prevent TB are available, the normal course of treatment is 12 months, making it difficult for people to comply with treatment especially in countries where access to care is a problem as is monitoring medication. In most developing countries preventive therapy for high risk individuals is not given because of limited resources. Researchers at the Johns Hopkins School of Public have found that a simplified regimen of twice-weekly doses of isoniazid preventive therapy administered for six months or rifampicin and pyrazinamide administered for only two months provided similar overall protection against tuberculosis in HIV-infected, PPD-positive adults.
The study was published in the March 14, 1998 issue of Lancet. Lead author Neal Halsey, MD, professor, International Health, said, "We need to look for innovative and practical ways to prevent TB in developing countries. The current strategy of emphasizing, early diagnosis and treatment of active cases can be improved upon with minimal added resources."
The study looked at 750 participants who were randomly assigned to receive either six months of isoniazid or two months of rifampicin and pyrazinamide given just twice per week. All participants were HIV positive and had a positive purified-protein derivative (PPD) skin test but no signs of active disease. Both regimens proved to be effective in preventing active TB. However, compliance with treatment was higher for those who received the shorter course of treatment. Adherence was strongly associated with duration of treatment. Co-author Richard Chaisson, MD, associate professor, International Health said, "This is great leap forward in finding a way to prevent TB in a lot of people who previously would not have been able to receive appropriate preventive measures."
The results of this study were presented to an expert panel assembled last month by UNAIDS and the World Health Organization that considered treatments to prevent tuberculosis in people with HIV. The two regimens used by the Hopkins researchers will be the centerpiece of new global recommendations, expected to be issued later this year.
Materials provided by Johns Hopkins School Of Public Health. Note: Content may be edited for style and length.
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