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Multi-therapy regimens similar to standard regimen for TB prevention in adults with HIV
Martinson NA.N Eng J Med.2011;365:11-20.
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Three new prophylactic treatment regimens for latent tuberculosis in HIV-infected adults resulted in similar — but not superior — efficacy to the standard 6-month isoniazid therapy regimen, according to new findings published in The New England Journal of Medicine.
“Use of these regimens in clinical practice could substantially increase the number of patients who receive and complete preventive therapy,”Neil A. Martinson, MB, MPH, of the Center for Tuberculosis Research and the division of infectious diseases at Johns Hopkins University School of Medicine, and colleagues wrote in the study.
In the open-label, randomized trial, Martinson and colleagues evaluated three new regimens for latent TB and compared potency and durability with standard isoniazid treatment among HIV-infected patients with a positive TB skin test who were not taking antiretroviral therapy (n=1,148).
Participants were randomly assigned to one of four groups: Rifapentine (900 mg; Priftin, Sanofi-Aventis) 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 to a control regimen of isoniazid (300 mg) daily for 6 months. Primary outcome measure was TB-free survival.
Compared with an incidence rate of 3.6/100 person-years for active TB or mortality among controls, the rate was 3.1/100 person-years in the rifapentine/isoniazid group, 2.9/100 person-years in the rifampin/isoniazid group and 2.7/100 person-years in the continuous-isoniazid group (P>.05 for all).
Further, when compared with all other treatment groups, serious adverse events were more common among those assigned continuous isoniazid therapy (8.7/100 person-years to 15.4 /100 person-years vs. 18.4/100 person-years).
“Our findings, along with those of other investigators, suggest that continuous treatment with isoniazid may be effective in preventing reactivation of and reinfection with M. tuberculosis in Africa,” the researchers wrote. “More widespread use of preventive therapy, regardless of the regimen chosen, is essential to help control the epidemic of HIV-related tuberculosis.”
Disclosure: This research was funded by NIAID and others; ClinicalTrials.gov number, NCT00057122.
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