Effect of preventive treatment for tuberculosis in adults infected with HIV: systematic review of randomised placebo controlled trials

被引:106
作者
Wilkinson, D
Squire, SB
Garner, P
机构
[1] S African Med Council, Ctr Epidemiol Res So Africa, ZA-3935 Mtubatuba, South Africa
[2] Univ Liverpool, Liverpool Sch Trop Med, Trop Med Div, Liverpool L3 5QA, Merseyside, England
[3] Univ Liverpool, Liverpool Sch Trop Med, Int Hlth Div, Liverpool L3 5QA, Merseyside, England
关键词
D O I
10.1136/bmj.317.7159.625
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To determine whether preventive treatment for tuberculosis in adults infected with HIV reduces the frequency of tuberculosis and overall mortality. Design: Systematic review and data synthesis of randomised placebo controlled trials. Main outcome measures: Active tuberculosis, mortality, and adverse drug reaction requiring cessation of the study regimen. Outcomes stratified by status of purified protein derivative skin test Results: Four trials comprising 4055 adults from Haiti, Kenya, the United States, and Uganda were included. All compared isoniazid (6-12 months) with placebo, and one trial also compared multidrug treatment for 3 months with placebo. Mean follow up was 15-33 months. Overall, frequency of tuberculosis (relative risk 0.57, 95% confidence interval 0.41 to 0.79) was reduced in those receiving preventive. treatment compared with placebo: mortality was not significantly reduced (0.93, 0.83 to 1.05), In subjects positive for purified protein derivative receiving preventive treatment, the risk of tuberculosis was reduced substantially (0.32, 0.19 to 0.51) and the risk of death was reduced moderately (0.73, 0.57 to 0.95) compared with those taking placebo. In adults negative for purified protein derivative receiving preventive treatment, the risk of tuberculosis (0.82, 0.50 to 1.36) and the risk of death (1.02, 0.89 to 1.17) were not reduced significantly. Adverse drug reactions were more frequent, but not significantly so, in patients receiving drug compared with placebo (1.45, 0.98 to 2.14), Conclusions: Preventive treatment given for 3-12 months protects against tuberculosis in adults infected with HIV, at least in the short to medium term. Protection is greatest in subjects positive for purified protein derivative, in whom death is also less frequent. Long term benefits remain to be shown.
引用
收藏
页码:625 / 629
页数:9
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