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Short-Course TB Prophylaxis in HIV-Infected Persons.

Tuberculosis (TB) prophylaxis is recommended for all patients with HIV infection and latent TB infection, because of the high risk of developing active TB. But 12-month isoniazid (INH)-containing regimens pose difficulties with adherence and toxicity. This cost-effectiveness analysis, based on data from six clinical trials, compared the standard 12-month regimen (daily INH) with several short-course regimens in hypothetical HIV-infected patients with CD4 cell counts of 200/mm³ or less and positive tuberculin skin tests.

Short-course regimens included INH daily or twice weekly for 6 months; INH and rifampin (RIF) daily for 3 months; INH, RIF, and pyrazinamide (PZA) daily for 3 months; and RIF and PZA daily or twice a week for 2 months. Compared with no prophylaxis, all regimens improved life expectancy (by 0.42 to 0.73 years), lifetime active-TB incidence (6 to 10 fewer cases per 100), and quality-adjusted life expectancy. All standard and short-course regimens yielded savings in direct medical care costs except for the daily INH/RIF/PZA regimen; it cost $1,941 to increase life expectancy by 1 quality-adjusted life year, it was the least effective, and it was associated with the most side effects. Of all the short-course regimens, 2 months of daily RIF/PZA produced cost savings and benefits most similar to the standard 12-month regimen.

Comment: TB prophylaxis is clearly indicated for patients with HIV infection. This study suggests that short-course regimens are reasonable options. The impact of highly active antiretroviral therapy on these treatment decisions remains to be seen.

— R Saitz

Published in Journal Watch General Medicine December 8, 1998

Citation(s):

Rose DN. Short-course prophylaxis against tuberculosis in HIV-infected persons: A decision and cost-effectiveness analysis. Ann Intern Med 1998 Nov 15 129 779-786.

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