Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain.
BACKGROUND
Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion.


METHODS
Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI).


RESULTS
A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9).


CONCLUSIONS
A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.
Diaz
Asuncion
A
Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. adiaz@isciii.es
Diez
Mercedes
M
Bleda
Maria Jose
MJ
Aldamiz
Mikel
M
Camafort
Miguel
M
Camino
Xabier
X
Cepeda
Concepcion
C
Costa
Asuncion
A
Ferrero
Oscar
O
Geijo
Paloma
P
Iribarren
Jose Antonio
JA
Moreno
Santiago
S
Moreno
Maria Elena
ME
Labarga
Pablo
P
Pinilla
Javier
J
Portu
Joseba
J
Pulido
Federico
F
Rosa
Carmen
C
Santamaría
Juan Miguel
JM
Telenti
Mauricio
M
Trapiella
Luis
L
Trastoy
Monica
M
Viciana
Pompeyo
P
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain; D016896:Treatment Outcome; D016903:Drug Monitoring
D000995:Antitubercular Agents