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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

  1. 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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