Long-term effect of preventive therapy for tuberculosis in a cohort of HIV-infected Zambian adults
| Autor: | Alwyn Mwinga, Dietmar Fuchs, Peter Godfrey-Faussett, Ida Lisse, Maria A Quigley, M. Hosp, Porter Jdh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Tuberculosis Immunology Population Antitubercular Agents Zambia HIV Infections Rate ratio Cohort Studies Internal medicine Isoniazid Humans Immunology and Allergy Medicine education Antibacterial agent education.field_of_study AIDS-Related Opportunistic Infections business.industry Mortality rate Pyrazinamide medicine.disease CD4 Lymphocyte Count Surgery Treatment Outcome Infectious Diseases Chemoprophylaxis Disease Progression Female Rifampin business Rifampicin Follow-Up Studies medicine.drug |
| Zdroj: | AIDS (London, England). 15(2) |
| ISSN: | 1473-5571 0269-9370 |
| Popis: | OBJECTIVE: To determine the long-term effect of preventive therapy (PT) for tuberculosis on the rates of tuberculosis, mortality and HIV progression. METHODS: In a randomized controlled trial, 1053 HIV-positive Zambian adults received isoniazid (H) for 6 months, rifampicin plus pyrazinamide (RZ) for 3 months, or a placebo. CD4 percentage, neopterin, absolute lymphocyte count and haemoglobin were measured from enrolment (absolute CD4 cell counts from 12 months after enrolment). Because PT reduced the incidence of tuberculosis, eligible placebo subjects were offered H. Here, tuberculosis and mortality rates are compared in the three original arms (intention to treat) using data beyond the end of the trial (average follow-up 3 years; maximum 7 years). RESULTS: There were 102 cases of tuberculosis and 281 deaths (rates 3.6 and 9.0/100 person-years, respectively). There was no significant difference between the tuberculosis rates in the H and RZ groups at any time. The effect of H/RZ on tuberculosis diminished over time (P = 0.011) but the cumulative risk of tuberculosis in the first 2.5 years was significantly lower in the H/RZ group than the placebo group (rate ratio 0.55; 95% confidence interval 0.32-0.93; P = 0.028). There was no significant effect of PT on mortality or progression markers. Tuberculosis was associated with an increased mortality (adjusted rate ratio 1.96; 95% confidence interval 1.21-3.18; P = 0.006). CONCLUSIONS: Both PT regimens protect against tuberculosis for at least 2.5 years but appear to have no effect on HIV progression or mortality. These results may be used in cost-effectiveness models of PT. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|