This article is more than 5 years old. Information may no longer be current.

Daily therapy superior to intermittent for TB in patients with HIV

A daily antituberculosis regimen prevented rifampicin resistance and was more effective than an intermittent regimen among patients with HIV with pulmonary tuberculosis who were receiving antiretroviral therapy, according to findings published in JAMA Internal Medicine.

“The benefit of daily over thrice-weekly antituberculosis therapy among HIV-positive patients with pulmonary tuberculosis (TB) who are receiving antiretroviral therapy remains unproven,” Narendran Gopalan, DNB, DTCD, from the National Institute for Research in Tuberculosis, New Delhi, and colleagues wrote.

Gopalan and colleagues performed an open-label, randomized clinical trial to determine how safe and effective daily anti-TB therapy regimens are for treating HIV-associated pulmonary TB in comparison to part-daily and intermittent regimens. The researchers enrolled 331 adults (76% male; mean age, 39 years; mean HIV viral load, 4.9 log₁₀ copies/mL; and median CD4 lymphocyte count, 138 cells/L) with HIV and newly culture-confirmed pulmonary TB.

The participants were randomly assigned to receive either daily, part-daily (daily in the intensive phase and intermittent in the continuation phase) or intermittent (three times weekly) anti-TB regimens. Participants started antiretroviral therapy in accordance with national guidelines. The researchers conducted clinical and sputum microbiological examinations of patients every month for 18 months.

The study revealed that 91% of participants receiving daily treatment, 80% of those receiving part-daily treatment and 77% of those receiving intermittent treatment had favorable responses to their anti-TB regimens. Hepatotoxic effects were observed in 9% of the daily regimen group and 2% of the intermittent group. Only participants receiving intermittent anti-TB therapy developed acquired rifampicin resistance.

TB recurred in six patients in the daily regimen group, four in the part-daily group and six in the intermittent group.

“A daily [anti-TB therapy] regimen for 6 months in HIV-positive patients with TB receiving concomitant [antiretroviral therapy] proved superior to an intermittent regimen in terms of efficacy and prevention of [acquired rifampicin resistance],” Gopalan and colleagues concluded. “A slightly higher incidence of hepatotoxic effects for patients receiving the daily regimen demanded closer monitoring of liver function.”

“The part-daily regimen did not confer any advantage over an intermittent regimen with regard to efficacy or tolerability but prevented [acquired rifampicin resistance],” they continued. “A higher CD4 lymphocyte count (150 cells/L) at the end of the intensive phase, rather than at baseline, was associated with a successful outcome.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.