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Clinical Investigations: TUBERCULOSIS |

Short-Course Rifamycin and Pyrazinamide Treatment for Latent Tuberculosis Infection in Patients With HIV Infection*: The 2-Year Experience of a Comprehensive Community-Based Program in Broward County, Florida

Masahiro Narita, MD; Michael Kellman, MPH; Diana L. Franchini, MD; Marie E. McMillan, RN; Elena S. Hollender, MD; David Ashkin, MD, FCCP
Author and Funding Information

*From the Broward County Health Department (Mr. Kellman, Dr. Franchini, and Ms. McMillan), Fort Lauderdale; A.G. Holley State Tuberculosis Hospital (Dr. Hollender), Lantana; Florida Department of Health, Bureau of Tuberculosis and Refugee Health (Dr. Ashkin), Tallahassee; and Division of Pulmonary and Critical Care Medicine (Dr. Narita), University of Miami School of Medicine, Miami, FL.

Correspondence to: David Ashkin, MD, FCCP, Florida Tuberculosis Controller, Medical Executive Director, A.G. Holley State Tuberculosis Hospital, 1199 West Lantana Rd, Lantana, FL 33462; e-mail: David_Ashkin@doh.state.fl.us



Chest. 2002;122(4):1292-1298. doi:10.1378/chest.122.4.1292
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Objectives: To determine the completion rate and tolerability of short-course rifamycin and pyrazinamide treatment of latent tuberculosis infection (LTBI) in HIV-infected patients through a comprehensive community-based program.

Design: Prospective cohort, with comparison to a historical control group.

Patients: Of 3,118 patients with HIV infection screened for LTBI between February 1999 and March 2001, 135 patients were placed on rifamycin/pyrazinamide for 2 months under directly observed therapy and were compared to a historical group comprised of 93 HIV-infected patients who were placed on self-administered treatment of isoniazid for 12 months between 1996 and 1998.

Results: Of 135 patients receiving rifamycin/pyrazinamide, 124 patients (92%) completed treatment; 5 patients had to discontinue treatment due to side effects (allergic skin reactions [n = 4], hepatitis [n = 1]). The completion rate of the historical group who received isoniazid therapy was 61% (57 of 93 patients; p < 0.001); none of those who received isoniazid experienced significant side effects.

Conclusion: In our experience, a comprehensive, community-based program of rifamycin/pyrazinamide for LTBI achieved significantly higher adherence than that of traditional isoniazid therapy, and thus may provide improved tuberculosis prevention in a community with high prevalence of HIV-infected patients.


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