Isoniazid as preventive therapy in HIV-infected intravenous drug abusers: a decision analysis

Article Abstract:

Individuals who are infected with the human immunodeficiency virus (HIV, which causes AIDS) and have tuberculosis (TB) in the dormant state, have a greater chance that TB infection will progress to active disease. Even without HIV infection, intravenous drug users have a high risk of TB. With HIV infection, the likelihood of intravenous drug users developing TB is compounded. HIV infection suppresses the immune system; one of the manifestations of this is no reactivity to skin tests. Therefore, when given skin tests to determine their reactivity against the bacteria that causes TB, HIV-infected individuals often have negative results. The test normally indicates past exposure and possible TB infection. Preventive treatment (to inhibit dormant TB infection from becoming active) with the drug isoniazid is recommended for individuals who are at high risk for TB and react positively to the tuberculin skin tests. The use of isoniazid in individuals who do not meet these criteria is controversial because isoniazid may cause toxic effects in the liver. A decision analysis describes the use of isoniazid as preventive therapy in a 35-year-old HIV-infected patient who previously used intravenous drugs. The analysis, which is performed with biases against the use of isoniazid for preventive therapy, showed that the drug is beneficial for all variational groups, except tuberculin-negative HIV-positive black women who are intravenous drug users. Black women may have an increased risk of death related to the use of isoniazid. Therefore, tuberculin testing is important for black women who are HIV-positive and use intravenous drugs, as the results of the test would determine if the women should receive therapy. Isoniazid treatment should be used in black and white men and white women who are intravenous drug abusers and are infected with HIV, even without tuberculin skin testing. Furthermore, this analysis showed that it is beneficial to prescribe isoniazid even when the suspected incidence of TB is as low as 3 to 8 percent. It is estimated that isoniazid therapy can improved life expectancy by as much as 285 days. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Dosage and administration, Antitubercular agents, Isoniazid, Intravenous drug abuse

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Tuberculosis outbreak among HIV-infected persons

Article Abstract:

During a period of about four and a half months, 12 cases of active pulmonary tuberculosis (TB) were diagnosed at a residential facility for patients infected with human immunodeficiency virus (HIV), which is responsible for acquired immunodeficiency syndrome (AIDS). The first patient diagnosed with TB was admitted to the hospital on December 19, 1990, and by April 4, 1991, 11 other patients from the same facility were found to have active TB. The last patient to be diagnosed had abnormal liver function, and was not given isoniazid (INH), a standard therapy for TB. Eleven other residents had no evidence of TB, and 10 of them opted to take isoniazid. Four staff members had positive tuberculin skin tests, but chest X-rays showed no evidence of active disease. Three of the affected patients died, and TB was considered to have contributed to two of these deaths. TB can spread rapidly among persons with impaired immune systems living together in a communal setting. A previous study indicated that HIV-infected persons with latent remote tuberculous infection are at high risk of developing clinically active disease. This cluster of new cases of tuberculosis among HIV-infected patients demonstrates that TB can progress rapidly from the time of infection to active disease. TB screening is important for all HIV-infected persons, as well as for those who are at high risk for HIV infection before they enter nursing homes or other communal living facilities. Health care workers should be familiar with the symptoms of TB and watch for them among their patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diseases, AIDS patients

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Defending the public's health against tuberculosis

Article Abstract:

The health care infrastructure to control tuberculosis must be re-built. In 1972, the federal government eliminated funding for most tuberculosis control programs because the disease appeared to be on the decline. However, the disease has made a comeback in the 1980's and 1990's. It often strikes homeless people and drug or alcohol addicts who are unable to comply with treatment. Consequently, the bacterium that causes tuberculosis has become resistant to many antituberculosis drugs. Civil detention of noncompliant patients could improve the management of tuberculosis, which still kills more people than any other infectious disease.

Care and treatment, Editorial, Demographic aspects, Drug resistance in microorganisms, Microbial drug resistance

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