Shorter Treatment for TB

One month of once-daily isoniazid/rifapentine is noninferior to 9 months of isoniazid (9H) alone for the treatment of tuberculosis (TB) in patients with human immunodeficiency virus (HIV), according to a recent study.

Findings from the study were presented by Richard E. Chaisson, MD, at the Conference on Retroviruses and Opportunistic Infections, which took place from March 4 to 7, 2018, in Boston, Massachusetts.
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For their study, Dr Chaisson and colleagues assessed 3000 HIV patients aged 13 years or older living in areas of high TB burden or who were TB skin test (TST)/Interferon-ϒ release assay (IGRA) positive.

Patients were randomly assigned to treatment with either 1 month of daily 300 mg H plus 450 to 600 mg P (1HP) or daily 300 mg 9H. Follow-up lasted 3 years after the last enrollment.

A total of 634 patients had positive TST or IGRA. Results indicated that the primary endpoint of active TB, TB death, or death from an unknown cause occurred in 34 patients receiving 1HP (incidence rate 0.69 per 100 person-years) and 35 patients receiving 9H (incidence rate 0.72 per 100 person-years).

The researchers noted that rates of the primary endpoint were higher among patients not treated with antiretroviral therapy upon study entry and in those with a positive TST or IGRA, with no difference observed between treatment groups.

Approximately 5.6% of 1HP patients and 7.1% of 9H patients experienced serious adverse events.

“Once daily 1HP was non-inferior to 9H, had fewer adverse events, and was more likely to be completed in HIV-infected adults and adolescents,” the researchers concluded. “This ultra-short course TB preventive therapy could be an important tool to control HIV-related TB.”

—Christina Vogt

Reference:

Swindells S, Ramchandani R, Gupta A, et al. One month of rifapentine/isoniazid to prevent TB in people with HIV. Paper presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2018; Boston, MA. http://www.croiconference.org/sessions/one-month-rifapentineisoniazid-prevent-tb-people-hiv-brief-tba5279.