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* From the Broward County Health Department (Mr. Kellman, Dr. Franchini, and Ms. McMillan), Fort Lauderdale; A.G. Holley State Tuberculosis Hospital (Dr. Hollender), Lantana; Florida Department of Health, Bureau of Tuberculosis and Refugee Health (Dr. Ashkin), Tallahassee; and Division of Pulmonary and Critical Care Medicine (Dr. Narita), University of Miami School of Medicine, Miami, FL.
Correspondence to: David Ashkin, MD, FCCP, Florida Tuberculosis Controller, Medical Executive Director, A.G. Holley State Tuberculosis Hospital, 1199 West Lantana Rd, Lantana, FL 33462; e-mail: David_Ashkin{at}doh.state.fl.us
Objectives: To determine the completion rate and tolerability of short-course rifamycin and pyrazinamide treatment of latent tuberculosis infection (LTBI) in HIV-infected patients through a comprehensive community-based program.
Design: Prospective cohort, with comparison to a historical control group.
Patients: Of 3,118 patients with HIV infection screened for LTBI between February 1999 and March 2001, 135 patients were placed on rifamycin/pyrazinamide for 2 months under directly observed therapy and were compared to a historical group comprised of 93 HIV-infected patients who were placed on self-administered treatment of isoniazid for 12 months between 1996 and 1998.
Results: Of 135 patients receiving rifamycin/pyrazinamide, 124 patients (92%) completed treatment; 5 patients had to discontinue treatment due to side effects (allergic skin reactions [n = 4], hepatitis [n = 1]). The completion rate of the historical group who received isoniazid therapy was 61% (57 of 93 patients; p < 0.001); none of those who received isoniazid experienced significant side effects.
Conclusion: In our experience, a comprehensive, community-based program of rifamycin/pyrazinamide for LTBI achieved significantly higher adherence than that of traditional isoniazid therapy, and thus may provide improved tuberculosis prevention in a community with high prevalence of HIV-infected patients.
Key Words: HIV • isoniazid • rifabutin • rifampin • tuberculosis
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