Interventions for Tuberculosis Control and Elimination 2002
Interventions for Tuberculosis Control and Elimination 2002
Interventions for Tuberculosis Control and Elimination 2002
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In Cité Soleil <strong>and</strong> Petit Place Cazeau, Haiti, patients with HIV infection<br />
<strong>and</strong> a tuberculin skin test induration of five or more millimeters were<br />
r<strong>and</strong>omly assigned to receive either isoniazid <strong>for</strong> 24 weeks or rifampicin<br />
plus pyrazinamide <strong>for</strong> eight weeks. 901 All drugs were given twice weekly,<br />
the first weekly dose directly observed, the second self-administered. The<br />
overall protection af<strong>for</strong>ded by the rifampicin-containing regimen was minus<br />
30%, with confidence intervals overlapping zero. During the first ten<br />
months after entry, the risk among isoniazid recipients was significantly<br />
lower than among rifampicin recipients.<br />
Similarly, in Lusaka, Zambia, isoniazid <strong>for</strong> six months gave better protection<br />
than rifampicin plus pyrazinamide <strong>for</strong> three months, but the confidence<br />
intervals were wide, the difference was not statistically significant,<br />
<strong>and</strong> the protective effect from both arms was lost after two to three years. 885<br />
The long-term evaluation showed that protection lasted <strong>for</strong> about two <strong>and</strong><br />
a half years <strong>and</strong> none of the regimens appeared to have an effect on HIV<br />
progression or mortality. 903<br />
In a multi-center study involving 53 treatment units in Brazil, Haiti,<br />
Mexico, <strong>and</strong> the United States, a total of 1,583 HIV-infected patients were<br />
r<strong>and</strong>omized to receive either isoniazid <strong>for</strong> twelve months (control arm) or<br />
rifampicin plus pyrazinamide <strong>for</strong> two months (experimental arm). 902 Among<br />
the inclusion criteria were the presence of a tuberculin skin test reaction of<br />
five or more millimeters of induration. For bacteriologically confirmed<br />
cases, the relative protection of the two-month regimen was 33% <strong>for</strong> bacteriologically<br />
confirmed, <strong>and</strong> five per cent <strong>for</strong> confirmed <strong>and</strong> probable cases.<br />
The 95% confidence interval was reasonably narrow, overlapped zero, <strong>and</strong><br />
142<br />
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Figure 88. Protection against tuberculosis with rifampicin containing preventive<br />
therapy compared to isoniazid preventive therapy (equivalence studies) among persons<br />
with HIV infection or silicosis. 885,892,901,902
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