[Primary chemoprevention of tuberculosis in HIV-infected patients in non-industrialized countries].
In randomized placebo-controlled trials in Haïti, Zambia and Uganda, prophylactic use of isoniazid (INH) for 6 to 12 months reduced the annual incidence of tuberculosis in HIV-infected patients by more than 50 per cent. For several years, WHO, IUTATLD and CDC have recommended that HIV-positive patients testing positive in a PPD test should be treated with INH as a form of anti-tuberculosis chemoprophylaxis (ATC). Whilst these recommendations are easy to follow in industrialized countries, widespread use of ATC in developing countries remains problematic because: (i) It is unknown what proportion of patients are likely to be re-infected at the end of ATC in countries where TB is endemic; (ii) It is possible that resistant bacilli may be selected due to the incomplete exclusion from the ATC program of patients with active TB at enrollment; (iii) It is difficult to identify asymptomatic carriers of M. tuberculosis at enrollment; (iv) It is doubtful that all patients will comply with a treatment regime which lasts several months; (v) The cost of a widespread ATC program, whose full benefit remains to be evaluated, may be difficult to justify. This paper attempts to review these issues and demonstrates the need for more population-based clinical trials in the field.
Anglaret
X
X
Centre de diagnostic et de recherches surle sida et les infections opportunistes (CEDRES), CHU de Treichville, Abidjan, Côte d'Ivoire.
Dabis
F
F
Batungwanayo
J
J
Perronne
C
C
Taelman
H
H
Bonard
D
D
Sylla-Koko
F
F
Leroy
V
V
Van de Perre
P
P
Vildé
J L
JL
Salamon
R
R
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D018890:Chemoprevention; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D019049:Developed Countries; D003906:Developing Countries; D004352:Drug Resistance, Microbial; D006205:Haiti; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000627:therapeutic use*; D009169:Mycobacterium tuberculosis; D010349:Patient Compliance; D010919:Placebos; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control*; D014454:Uganda; D014481:United States; D014944:World Health Organization; D015024:Zambia
D000995:Antitubercular Agents; D010919:Placebos; D007538:Isoniazid