Drugs for preventing tuberculosis in HIV infected persons

BACKGROUND: People with HIV have a increased risk of developing tuberculosis. Preventive therapy may help prevent progression of tuberculosis infection to disease.

OBJECTIVES: The objective of this review was to assess the effects of preventive therapy with anti-tuberculosis drugs in people with HIV infection.

SEARCH STRATEGY: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles were searched. Researchers in the field were contacted.

SELECTION CRITERIA: Randomised trials of anti-tuberculosis drugs in people with HIV infection but without evidence of active tuberculosis.

DATA COLLECTION AND ANALYSIS: One reviewer assessed eligibility and trial quality. Study authors were contacted for additional information.

MAIN RESULTS: Seven trials were included. Compared to placebo, preventive therapy was associated with a lower incidence of active tuberculosis (Peto odds ratio 0.54, 95% confidence interval 0.39 to 0.76). Risk of death (OR 0.96 95%CI 0.82 to 1.13) was not significantly different in the two groups. Incidence of tuberculosis was reduced in people with a positive tuberculin skin test (OR 0.35, 95% confidence interval 0.21 to 0.59), but was not significantly lower in those with a negative skin test (OR 0.82, 95% confidence interval 0.51 to 1.31). Similarly death was less frequent in those with a positive skin test who received preventive therapy (OR 0.70, 95% confidence interval 0.50 to 0/98), but this difference was not observed among those with a negative skin test OR 1.04, 95% confidence interval 0.86 to 1.28). Each regimen (isoniazid alone, isoniazid plus rifampicin, isoniazid plus rifampicin plus pyrazinamide, rifampicin plus pyrazinamide) had similar protective effects against active tuberculosis.

REVIEWER'S CONCLUSIONS: Preventive therapy appears to be effective in reducing incidence of tuberculosis, and death from tuberculosis in HIV infected adults with a positive tuberculin skin test, at least in the short to medium term. Choice of regimen will depend on issues of adherence, side effects profile, cost and drug resistance.