title: New regimens to prevent tuberculosis in adults with HIV infection.
abstract: BACKGROUND
  Treatment of latent tuberculosis in patients infected with the human immunodeficiency virus (HIV) is efficacious, but few patients around the world receive such treatment. We evaluated three new regimens for latent tuberculosis that may be more potent and durable than standard isoniazid treatment.
  
  
  METHODS
  We randomly assigned South African adults with HIV infection and a positive tuberculin skin test who were not taking antiretroviral therapy to receive rifapentine (900 mg) plus isoniazid (900 mg) weekly for 12 weeks, rifampin (600 mg) plus isoniazid (900 mg) twice weekly for 12 weeks, isoniazid (300 mg) daily for up to 6 years (continuous isoniazid), or isoniazid (300 mg) daily for 6 months (control group). The primary end point was tuberculosis-free survival.
  
  
  RESULTS
  The 1148 patients had a median age of 30 years and a median CD4 cell count of 484 per cubic millimeter. Incidence rates of active tuberculosis or death were 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, as compared with 3.6 per 100 person-years in the control group (P>0.05 for all comparisons). Serious adverse reactions were more common in the continuous-isoniazid group (18.4 per 100 person-years) than in the other treatment groups (8.7 to 15.4 per 100 person-years). Two of 58 isolates of Mycobacterium tuberculosis (3.4%) were found to have multidrug resistance.
  
  
  CONCLUSIONS
  On the basis of the expected rates of tuberculosis in this population of HIV-infected adults, all secondary prophylactic regimens were effective. Neither a 3-month course of intermittent rifapentine or rifampin with isoniazid nor continuous isoniazid was superior to 6 months of isoniazid. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00057122.).
authors: Center for Tuberculosis Research and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
authors: Neil A
authors: NA
authors: Martinson
authors: Grace L
authors: GL
authors: Barnes
authors: Lawrence H
authors: LH
authors: Moulton
authors: Reginah
authors: R
authors: Msandiwa
authors: Harry
authors: H
authors: Hausler
authors: Malathi
authors: M
authors: Ram
authors: James A
authors: JA
authors: McIntyre
authors: Glenda E
authors: GE
authors: Gray
authors: Richard E
authors: RE
authors: Chaisson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002423:Cause of Death; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012293:Rifampin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D012306:Risk; D014376:Tuberculosis / Q000517:prevention & control*; D018088:Tuberculosis, Multidrug-Resistant
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin; C018421:rifapentine