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2–46 | Clinical Manual for Management of the HIV-Infected Adult/2006
Randomized trials in Haiti, Zambia, and Uganda have
demonstrated that a 6-month course of INH reduced
the risk of active TB among HIV-infected persons
by 60% over 1-5 years of follow-up. In resourcelimited
settings, the usual course of treatment is 6
months of daily INH treatment taken by the patient
without observation, but with monthly clinic visits and
prescription refills. A minimum of 180 doses taken
within 9 months, or 80% of the doses within 6 months,
is considered a complete regimen. Often, pyridoxine
10-25 mg daily also is provided. In studies of HIVnegative
persons, the benefit of INH lasts 2 years.
Current guidelines do not recommend prolonging INH
preventive therapy beyond 6 months or repeating IPT
in subsequent years; these issues are under study.
INH is the only treatment for LTBI that is available
in much of the world. Rifampin and rifabutin
combinations are very expensive and are not used for
treatment of LTBI in resource-limited settings. The
combination of rifampin and pyrazinamide is toxic and
is not recommended in either industrialized or resourcelimited
settings.
Treatment of HIV/TB-coinfected persons requires
adequate supplies of HIV test kits, materials for
tuberculin testing, INH, pyridoxine, a trained staff, a
mechanism for promoting adherence, and a system of
record keeping, along with the willingness of patients to
participate. In Uganda, only a small proportion of HIVinfected
persons who were offered tuberculin testing
eventually took a 6-month course of INH. Use of IPT
requires substantial resources and planning. Projects
and countries using this approach to TB prevention will
have to identify resources for all of these requirements.
References
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Blumberg HM, Leonard MK, Jasmer RM. Update
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Bucher HC, Griffith LE, Guyatt GH, et al. Isoniazid
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Quigley MA, Mwinga A, Hosp M, et al. Long-term
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