Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials. NLM AIDSLINE Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

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Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials.

AIDS. 1999 Mar 11;13(4):501-7. Unique Identifier : AIDSLINE MED/99211236
Bucher HC; Griffith LE; Guyatt GH; Sudre P; Naef M; Sendi P; Battegay M; Medizinische Universitats-Poliklinik, Kantonsspital Basel,; Switzerland.

Abstract: OBJECTIVES: To evaluate the efficacy of isoniazid for the prevention of tuberculosis in tuberculin skin test-positive and negative individuals with HIV infection. DESIGN: Meta-analysis of randomized controlled trials. SETTING: Seven trials from Mexico, Haiti, the United States, Zambia, Uganda and Kenya. PATIENTS: Individuals free from tuberculosis, 2367 persons in the intervention and 2162 in the control groups. INTERVENTION: Comparison of isoniazid with placebo or no prophylaxis. METHODS: A systematic search of the literature was carried out from 1985 to October 1997 for randomized controlled trials of isoniazid prophylaxis in HIV-infected persons. Two reviewers evaluated the relevance of each candidate study and the validity of eligible trials. Studies were pooled using a random effect model, conducting secondary analyses for tuberculin skin test-positive and negative persons. RESULTS: Mean follow-up in trials varied between 0.4 and 3.2 years. Pooling all seven trials, a risk ratio was found for persons treated with isoniazid for developing tuberculosis of 0.58 [95% confidence interval (CI), 0.43-0.80] and 0.94 (95% CI, 0.83-1.07) for death. In groups of tuberculin skin test-positive and negative persons, the risk ratio of tuberculosis was 0.40 (95% CI, 0.24-0.65) and 0.84 (95% CI, 0.54-1.30), respectively, and the difference in the effectiveness of isoniazid versus placebo between these groups was statistically significant (P = 0.03, for the difference of summary estimates). Consistency of results was found across trials (P > 0.10, heterogeneity value) for all comparisons. CONCLUSIONS: Prophylaxis with isoniazid reduces the risk of tuberculosis in persons with HIV infection. The effect is restricted to tuberculin skin test-positive persons.
Keywords: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL Antitubercular Agents/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/ *PHARMACOLOGY AIDS-Related Opportunistic Infections/EPIDEMIOLOGY/MORTALITY/ *PREVENTION & CONTROL Follow-Up Studies Human Incidence Isoniazid/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/*PHARMACOLOGY Meta-Analysis Support, Non-U.S. Gov't Tuberculosis/EPIDEMIOLOGY/MORTALITY/*PREVENTION & CONTROLKWDclinicaltrialjournalarticlerandomizedcontrolledtrialantitubercularagents/administration&dosage/adverseeffects/KWDpharmacologyaids-relatedopportunisticinfections/epidemiology/mortality/KWDprevention&controlfollow-upstudieshumanincidenceisoniazid/administration&dosage/adverseeffects/KWDpharmacologymeta-analysissupport,non-uKWDsKWDgov'ttuberculosis/epidemiology/mortality/KWDprevention&control
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Copyright © 1999 - National Library of Medicine. Reproduced under license with the National Library of Medicine, Bethesda, MD.

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