Drugs for preventing tuberculosis in HIV infected persons.

backgroundPeople with HIV have a increased risk of developing tuberculosis. Preventive therapy may help prevent progression of tuberculosis infection to disease.

objectivesThe objective of this review was to assess the effects of preventive therapy with anti-tuberculosis drugs in people with HIV infection. SEARCH STRATEGY: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles were searched. Researchers in the field were contacted. SELECTION CRITERIA: Randomised trials of anti-tuberculosis drugs in people with HIV infection but without evidence of active tuberculosis. DATA COLLECTION AND ANALYSIS: One reviewer assessed eligibility and trial quality. Study authors were contacted for additional information. MAIN

resultsSeven trials were included. Compared to placebo, preventive therapy was associated with a lower incidence of active tuberculosis (Peto odds ratio 0.54, 95% confidence interval 0.39 to 0.76). Risk of death (OR 0.96 95%CI 0.82 to 1.13) was not significantly different in the two groups. Incidence of tuberculosis was reduced in people with a positive tuberculin skin test (OR 0.35, 95% confidence interval 0.21 to 0.59), but was not significantly lower in those with a negative skin test (OR 0.82, 95% confidence interval 0.51 to 1.31). Similarly death was less frequent in those with a positive skin test who received preventive therapy (OR 0.70, 95% confidence interval 0.50 to 0/98), but this difference was not observed among those with a negative skin test OR 1.04, 95% confidence interval 0.86 to 1.28). Each regimen (isoniazid alone, isoniazid plus rifampicin, isoniazid plus rifampicin plus pyrazinamide, rifampicin plus pyrazinamide) had similar protective effects against active tuberculosis. REVIEWER'S

conclusionsPreventive therapy appears to be effective in reducing incidence of tuberculosis, and death from tuberculosis in HIV infected adults with a positive tuberculin skin test, at least in the short to medium term. Choice of regimen will depend on issues of adherence, side effects profile, cost and drug resistance.