Drugs for preventing tuberculosis in HIV infected persons (Cochrane Review)

A substantive amendment to this systematic review was last made on 30 August 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: People with HIV have a increased risk of developing tuberculosis. Preventive therapy may help prevent progression of tuberculosis infection to disease.

Objectives: The objective of this review was to assess the effects of preventive therapy with anti-tuberculosis drugs in people with HIV infection.

Search strategy: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles were searched. Researchers in the field were contacted.

Selection criteria: Randomised trials of anti-tuberculosis drugs in people with HIV infection and with either a positive or a negatve tuberculin skin test, but without evidence of active tuberculosis.

Data collection and analysis: One reviewer assessed eligibility and trial quality. Study authors were contacted for additional information.

Main results: Seven trials were included. Compared to placebo, preventive therapy was associated with a lower incidence of active tuberculosis (Peto odds ratio 0.54, 95% confidence interval 0.39 to 0.76). Incidence of tuberculosis was reduced in people with a positive tuberculin skin test (OR 0.24, 95% confidence interval 0.14 to 0.40), but was not significantly lower in those with a negative skin test (OR 0.87, 95% confidence interval 0.56 to 1.36). Risk of death (OR 0.96 95%CI 0.82 to 1.13) was not significantly different in intervention and control groups. Similarly death was less frequent in those with a positive skin test who received preventive therapy (OR 0.77, 95% confidence interval 0.58 to 1.03), but this difference was not observed among those with a negative skin test OR 1.07, 95% confidence interval 0.88 to 1.30). Each regimen (isoniazid alone, isoniazid plus rifampicin, isoniazid plus rifampicin plus pyrazinamide, rifampicin plus pyrazinamide) had similar protective effects against active tuberculosis.

Reviewers' conclusions: Preventive therapy appears to be effective in reducing incidence of tuberculosis, and death from tuberculosis in HIV infected adults with a positive tuberculin skin test, at least in the short to medium term. Choice of regimen will depend on issues of adherence, side effects profile, cost and drug resistance.

Citation: Wilkinson D. Drugs for preventing tuberculosis in HIV infected persons (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

---

This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

The Cochrane Library is designed and produced by Update Software Ltd.

Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, UK
(Tel:+44 1865 513902; Fax:+44 1865 516918)

File Reference: AB000171.htm