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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
New regimens to prevent tuberculosis in adults with HIV infection
New England Journal of Medicine, Volume 365, No. 1, Year 2011
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Description
BACKGROUND: Treatment of latent tuberculosis in patients infected with the human immunodeficiency virus (HIV) is efficacious, but few patients around the world receive such treatment. We evaluated three new regimens for latent tuberculosis that may be more potent and durable than standard isoniazid treatment. METHODS: We randomly assigned South African adults with HIV infection and a positive tuberculin skin test who were not taking antiretroviral therapy to receive rifapentine (900 mg) plus isoniazid (900 mg) weekly for 12 weeks, rifampin (600 mg) plus isoniazid (900 mg) twice weekly for 12 weeks, isoniazid (300 mg) daily for up to 6 years (continuous isoniazid), or isoniazid (300 mg) daily for 6 months (control group). The primary end point was tuberculosis-free survival. RESULTS: The 1148 patients had a median age of 30 years and a median CD4 cell count of 484 per cubic millimeter. Incidence rates of active tuberculosis or death were 3.1 per 100 person-years in the rifapentine-isoniazid group, 2.9 per 100 person-years in the rifampin-isoniazid group, and 2.7 per 100 person-years in the continuous-isoniazid group, as compared with 3.6 per 100 person-years in the control group (P>0.05 for all comparisons). Serious adverse reactions were more common in the continuous-isoniazid group (18.4 per 100 person-years) than in the other treatment groups (8.7 to 15.4 per 100 person-years). Two of 58 isolates of Mycobacterium tuberculosis (3.4%) were found to have multidrug resistance. CONCLUSIONS: On the basis of the expected rates of tuberculosis in this population of HIV-infected adults, all secondary prophylactic regimens were effective. Neither a 3-month course of intermittent rifapentine or rifampin with isoniazid nor continuous isoniazid was superior to 6 months of isoniazid. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00057122.) Copyright © 2011 Massachusetts Medical Society.
Authors & Co-Authors
Martinson, Neil Alexander
United States, Baltimore
Johns Hopkins School of Medicine
South Africa, Johannesburg
University of the Witwatersrand
Barnes, Grace Link
United States, Baltimore
Johns Hopkins School of Medicine
Moulton, Lawrence H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Msandiwa, Regina
South Africa, Johannesburg
University of the Witwatersrand
Hausler, Harry Peter
South Africa, Bellville
University of the Western Cape
Ram, Malathi
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
McIntyre, James Alasdair
South Africa, Johannesburg
University of the Witwatersrand
Gray, Glenda E.
South Africa, Johannesburg
University of the Witwatersrand
Chaisson, Richard E.
United States, Baltimore
Johns Hopkins School of Medicine
Statistics
Citations: 346
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1056/NEJMoa1005136
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study