Short-course treatment as good as long for preventing TB in HIV patients
MedWire News: Short-course regimens of prophylactic treatment for preventing tuberculosis (TB) in HIV-infected patients are as efficacious as long courses, report researchers.
Even though incidence rates of TB or death in patients treated with rifapentine or rifampin plus isoniazid were similar, but not superior, to a long course of isoniazid, adherence to shorter regimens was better than adherence to the continuous protocol.
"New treatment options are urgently needed to help control TB globally, and simpler regimens will substantially increase the number of people receiving therapy," said Richard Chaisson, from the Johns Hopkins Center for Tuberculosis Research in Baltimore, Maryland, USA.
"This new, simpler treatment regimen with rifapentine and isoniazid is highly effective and could transform therapy for latent TB in both those co-infected with HIV and those not," he added.
Chaisson and colleagues randomly assigned 1148 South African adults with HIV infection and a positive tuberculin skin test to receive rifapentine (900 mg) plus isonazid (900 mg) for 12 weeks (n=328), rifampin (600 mg) plus isoniazid (900 mg) twice-weekly for 12 weeks (n=329), isoniazid (300 mg) daily for up to 6 years (n=164), or isoniazid (300 mg) daily for 6 months (control group, n=327).
The respective follow-up times for each treatment group was 4.0, 4.1, 3.9, and 3.9 years, and a total of 66 patients died during the study, the equivalent of 1.6 deaths per 100 person-years.
Overall, 78 patients were diagnosed with TB during the study period, giving a rate of 1.9 cases per 100 person-years.
Chaisson et al report no significant difference in rates of TB incidence or death between any of the three treatment groups compared with control patients, at 3.1 per 100 person-years in the rifapentine-isoniazid group, 2.9 per 100 person-years in the rifampin-isoniazid group, and 2.7 per 100 person-years in the continuous isoniazid group, compared with 3.6 per 100 person-years in the control group.
The 90% adherence rates were highest for the shortest treatment regimens, at 95.7% and 94.8% in the rifapentine-isoniazid and rifampin-isoniazid groups, compared with 83.8% and 89.1% in the 6-month isoniazid and continuous isoniazid groups.
Furthermore, serious adverse reactions (defined as grade 3 or 4 adverse events according to the Division of AIDS toxicity table, hospitalization, or death) were more common in the continuous isoniazid group than the other treatment groups, report the researchers in the NEJM.
"As a result of our research, physicians should feel more comfortable with recommending a simplified treatment approach, knowing now that their patients are more likely to complete treatment as directed and remain disease free," concluded co-investigator Neil Martinson (Johns Hopkins).
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By Sarah Guy