Effectiveness of isoniazid chemoprophylaxis for HIV-infected drug users at high risk for active tuberculosis

Marc N. Gourevitch, Diana Hartel, Peter A. Selwyn, Ellie Schoenbaum, Robert S. Klein

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective: To define the effectiveness of chemoprophylaxis, outside of a clinical trial setting, in preventing tuberculosis among tuberculin-reactive and anergic HIV-infected drug users at high risk of developing active tuberculosis. Design: An observational cohort study. Setting: Methadone maintenance treatment program with on-site primary care. Participants: Current or former drug users enrolled in methadone treatment. Interventions: Annual skin testing for tuberculosis infection and anergy was performed, and eligible patients were offered daily isoniazid for 12 months and followed prospectively. Main outcome measure: The development of active tuberculosis. Results: A total of 155 persons commenced chemoprophylaxis. Among tuberculin reactors, tuberculosis rates were 0.51 and 2.07/100 person-years in those completing 12 months versus those not taking prophylaxis [rate ratio 0.25, 95% confidence interval (CI) 0.06-1.01]. Among anergic individuals, comparable rates were 0 and 1.44/100 person-years. Lower tuberculosis rates among completers were not attributable to differences in immune status between the treated and untreated groups. Conclusion: The completion of isoniazid chemoprophylaxis was associated with a marked reduction in tuberculosis risk among tuberculin reactors and anergic persons in this high-risk population. These data support aggressive efforts to provide a complete course of preventative therapy to HIV-infected tuberculin reactors, and lend weight to the findings of others that isoniazid can reduce the rate of tuberculosis in high-risk anergic HIV-infected persons.

Original languageEnglish (US)
Pages (from-to)2069-2074
Number of pages6
JournalAIDS
Volume13
Issue number15
DOIs
StatePublished - 1999

Fingerprint

Isoniazid
Chemoprevention
Drug Users
Tuberculosis
HIV
Tuberculin
Methadone
cutaneous Tuberculosis
Observational Studies
Primary Health Care
Cohort Studies
Therapeutics
Outcome Assessment (Health Care)
Clinical Trials
Confidence Intervals
Weights and Measures
Infection
Population

Keywords

  • Anergy
  • Chemoprophylaxis
  • Drug users
  • HIV
  • Isoniazid
  • Purified protein derivative
  • Tuberculosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Effectiveness of isoniazid chemoprophylaxis for HIV-infected drug users at high risk for active tuberculosis. / Gourevitch, Marc N.; Hartel, Diana; Selwyn, Peter A.; Schoenbaum, Ellie; Klein, Robert S.

In: AIDS, Vol. 13, No. 15, 1999, p. 2069-2074.

Research output: Contribution to journalArticle

Gourevitch, Marc N. ; Hartel, Diana ; Selwyn, Peter A. ; Schoenbaum, Ellie ; Klein, Robert S. / Effectiveness of isoniazid chemoprophylaxis for HIV-infected drug users at high risk for active tuberculosis. In: AIDS. 1999 ; Vol. 13, No. 15. pp. 2069-2074.
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