Tuberculosis preventive therapy for people living with HIV: A systematic review and network meta-analysis

PLoS MedicineYanes-Lane M, Ortiz-Brizuela E, Campbell JR, et al. | October 06, 2021

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Among people living with HIV (PLHIV), rifamycin-containing regimens were found to be safer and at least as effective as isoniazid regimens in preventing tuberculosis (TB) as well as death and thus, deserve to be considered a component of routine care in PLHIV.

  • PLHIV carry a high risk of developing and dying of TB disease.

  • Various tuberculosis preventive therapy (TPT) regimens for PLHIV exist (i.e., 6, 12, and 36 months of isoniazid (6H, 12H, and 36H), 3 months of isoniazid plus rifampin (3HR), and 1 or 3 months of isoniazid plus rifapentine (1HP and 3HP).

  • This is a systematic review and network meta-analysis (NMA) of studies contrasting 2 or more of the currently recommended TPT regimens in PLHIV.

  • Via adopting the NMA approach, data from published randomized controlled trials were utilized for indirect comparisons of different TPT strategies.

  • Better completion rates were reported for shorter, rifamycin-containing regimens (3HR, 3HP, and 1HP) vs isoniazid-based regimens (6H, 12H, and 36H).

  • A higher mortality risk and a higher frequency of severe adverse events were observed with isoniazid-based regimens vs rifamycin-containing regimens.

  • Rifamycin-containing regimens, relative to isoniazid-based regimens, were equally good at preventing TB disease, and no evidence showed that they contributed to development of drug resistance.

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