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AIDS. 2003 Sep 26;17(14):2063-70.

Efficacy of secondary isoniazid preventive therapy among HIV-infected Southern Africans: time to change policy?

Author information

1
Aurum Health Research, Welkom, South Africa.

Abstract

OBJECTIVE:

To determine the efficacy of secondary preventive therapy against tuberculosis (TB) among gold miners working in South Africa.

DESIGN:

An observational study.

SETTING:

Health service providing comprehensive care for gold miners.

METHODS:

The incidence of recurrent TB was compared between two cohorts of HIV-infected miners: one cohort (n = 338) had received secondary preventive therapy with isoniazid (IPT) and the other had not (n = 221).

RESULTS:

The overall incidence of recurrent TB was reduced by 55% among men who received IPT compared with those who did not (incidence rates 8.6 and 19.1 per 100 person-years, respectively; incidence rate ratio, 0.45; 95% confidence interval 0.26-0.78). The efficacy of isoniazid preventive therapy was unchanged after controlling for CD4 cell count and age. The number of person-years of IPT required to prevent one case of recurrent TB among individuals with a CD4 cell count < 200 x 106 cells/l, and > or = 200 x 106 cells/l was 5 and 19, respectively.

CONCLUSION:

Secondary preventive therapy reduces TB recurrence: the absolute impact appears to be greatest among individuals with low CD4 cell counts. International TB preventive therapy guidelines for HIV-infected individuals need to be expanded to include recommendations for secondary preventive therapy in settings where TB prevalence is high.

[Indexed for MEDLINE]

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