Notice to Readers
Use of Short-Course Tuberculosis Preventive Therapy Regimens
in HIV-Seronegative Persons
In the MMWR Recommendations and Reports, Prevention and
Treatment of
Tuberculosis Among Patients Infected with Human Immunodeficiency
Virus:
Principles of Therapy and Revised Recommendations (1), CDC has
recommended
the use of a 2-month regimen of daily rifampin and pyrazinamide
(2RZ) as an
alternative to a 12-month regimen of isoniazid for the prevention
of
tuberculosis in HIV-infected persons with positive tuberculin skin
test
reactions. This recommendation is based on the results of several
randomized, controlled clinical trials in HIV-infected persons.
Next year,
CDC, in conjunction with the American Thoracic Society, expects to
issue
new guidelines on screening and preventive therapy for tuberculosis
that
will include a recommendation on the use of the 2RZ regimen for
HIV-negative persons for whom preventive therapy is indicated. This
recommendation will note that a comparative trial of the 2RZ
regimen in
HIV-negative persons has not been conducted and that additional
data will
be needed on acceptability and toxicity to determine whether it is
a
cost-effective alternative to longer courses of isoniazid.
Until new guidelines are issued, the regimen for HIV-positive
persons
can be used for HIV-negative persons, following the same guidelines
for
HIV-positive persons. This regimen may be useful especially in
settings
where provision of longer courses of preventive therapy has not
been
feasible (e.g., jails). CDC's Division of Tuberculosis Elimination
(DTBE),
National Center for HIV, STD, and TB Prevention, will collect
information
on completion of preventive therapy from selected programs using
the
short-course regimen. Programs interested in working with the DTBE
in this
effort can contact CDC, telephone (404) 639-8123.
Reference
CDC. Prevention and treatment of tuberculosis among patients
infected
with human immuno-deficiency virus: principles of therapy and
revised
recommendations. MMWR 1998;47 (no. RR-20).
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