Shorter Duration Tuberculosis Prevention Option Available for People Living With HIV

A study presented at the 25th Conference on Retroviruses and Opportunistic Infections (CROI) has found that a 1-month course of antibiotics is as safe and effective as the commonly recommended 9-month course of antibiotics in preventing tuberculosis (TB) in those with HIV.

For the study, researchers compared a daily, month-long regimen of the antibiotics rifapentine and isoniazid (1HP) with the standard nine-month regimen of daily isoniazid (9H). A total of 3000 participants—all aged 13 years or older—were recruited by 45 sites spanning 10 countries between 2012 to 2014, with an average of 3 years follow-up.

All participants either lived in a country with high TB burden or tested positive for latent TB infection. At the start of the study, about half of participants were taking antiretroviral medication.

“More than 1000 people with HIV die of tuberculosis every day,” said Richard Chaisson, MD, a study author who presented the findings at CROI. “1HP could contribute to improvements in global tuberculosis control.”

Globally, TB is most common serious opportunistic infection in those living with HIV. In fact, according to the World Health Organization (WHO), in 2016, TB was responsible for 40% of the deaths among people with HIV, despite the fact that the disease is treatable and preventable.

Overall, TB incidence was lower than expected in both arms of the study, with 32 of the 1HP participants and 33 of the 9H participants developing active TB.

Previous research has shown that those living with HIV who have TB should receive treatment for both conditions simultaneously; results from this study support that recommendation. In both 1HP and 9H groups, participants who were not on antiretroviral therapy at the start of the study and those who had positive skin or blood TB tests showed higher rates of active TB.

Both antibiotic regimens were safe, with fewer adverse events occurring in the 1HP arm of the study. The results showed slightly higher hematologic toxicity in the 1HP group and higher liver and neurologic toxicity in the 9H group.

Treatment adherence was significantly higher in the shorter regimen. Of patients assigned to the short 1HP arm, 97% completed the full antibiotic course, compared to 90% of participants in the nine-month arm. Given the effectiveness of both treatment regimens, the difference in adherence is especially important.

“These results have the potential to dramatically change clinical practice by offering people living with HIV who are at risk of developing active tuberculosis an additional, shorter-duration prevention option that is safe, effective and more convenient,” said NIAID Director Anthony S. Fauci, M.D. in a statement. “This study also will inform future research on prevention of tuberculosis disease among HIV-negative people at risk for developing active tuberculosis.”

A previous version of this article has been posted on MDMagazine.com.