Preventive medicine for HIV-infected patients: an analysis of isoniazid prophylaxis for tuberculin reactors and for anergic patients.
OBJECTIVE
To analyze the policies of isoniazid prophylaxis for human immunodeficiency virus (HIV)-infected tuberculin reactors and for HIV-infected anergic patients with unknown tuberculin status.


METHODS
Transition-state model of clinical immune deterioration of HIV-infection over ten years, review of published data, and a survey of AIDS experts. Outcome measures are the numbers of tuberculosis cases and deaths prevented and isoniazid toxicity cases and deaths occurring with prophylaxis.


METHODS
Hypothetical cohorts of HIV-infected 40-year-olds.


RESULTS
Because the tuberculosis activation rate is so high in HIV-infected patients, the benefits of prophylaxis far outweigh the risks of isoniazid toxicity for tuberculin reactors with HIV infection at any stage of immune function: 1,469-2,868 tuberculosis cases and 170-274 deaths are prevented per 10,000 cohort over ten years, depending upon the cohort's initial immune state. The benefits of prophylaxis outweigh the risks of isoniazid toxicity for anergic HIV-infected patients if they come from a community with a 2% to 3% or greater prevalence of Mycobacterium tuberculosis infection.


CONCLUSIONS
Isoniazid prophylaxis is a reasonable prevention measure for HIV-infected tuberculin reactors and for many HIV-infected anergic patients.
Department of Medicine, Mount Sinai School of Medicine, New York, New York.
D N
DN
Rose
C B
CB
Schechter
H S
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Sacks
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D007958:Leukocyte Count; D016176:T-Lymphocyte Subsets; D014374:Tuberculin Test; D014376:Tuberculosis / Q000517:prevention & control*
D007538:Isoniazid