HIV Treatment Bulletin - October 2003
Graham McKerrow, HIV i-Base

Treatment of latent TB with a two-month therapy regimen of rifampin and pyrazinamide (RZ) can cause severe liver damage and even death, according to a study by the US Centers for Disease Control and Prevention (CDC).

The CDC has previously reported surveillance data of severe liver damage in patients treated with a daily and twice-weekly two-month regimen of RZ. To estimate the incidence of severe liver damage they collected data on patients in the United States who received treatment between January 2000 and June 2002. [1] CDC found reports of 48 latent TB patients with confirmed cases of severe liver injury after receiving the treatment. Eleven patients died. As a result the American Thoracic Society and CDC now recommend that this regimen should not normally be offered to people with latent TB.

The agency recommends a nine-month regimen of isoniazid as the preferred treatment for latent TB. [2] It also says that rifampin and pyrazinamide should continue to be used in multidrug regimens for the treatment of active TB disease.

Ref: Centers for Disease Control and Prevention (CDC); American Thoracic Society. Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection - United States, 2003. MMWR Aug 8, 2003 / 52(31);735-739.

CDC Summary: Treatment of Latent Tuberculosis Infection (LTBI)

1. DC. Update: Fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations – United States, 2001. MMWR 2001;50 (No.34).
   MMWR August 31, 2001 / 50(34);733-5
2. CDC. Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection. MMWR Aug 8, 2003 / 52(31);735-739

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