0
Clinical Investigations: TUBERCULOSIS |

Adverse Events and Treatment Completion for Latent Tuberculosis in Jail Inmates and Homeless Persons*

Mark N. Lobato, MD; Randall R. Reves, MD, MSc; Robert M. Jasmer, MD; John C. Grabau, PhD; Naomi N. Bock, MD; Nong Shang, PhD; for the 2RZ Study Group
Author and Funding Information

Affiliations: *From the Division of Tuberculosis Elimination (Drs. Lobato, Bock, and Shang), National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention; the Denver Public Health Department (Dr. Reves), Denver, CO; the University of California-San Francisco (Dr. Jasmer), San Francisco, CA; and the Bureau of Tuberculosis Control (Dr. Grabau), New York State Department of Health, New York, NY.,  For a list of 2EZ Study Group members see the Appendix.

Correspondence to: Mark N. Lobato, MD, CDC, 1600 Clifton Rd, Mailstop E-10, Atlanta, GA 30333; e-mail: mnl0@cdc.gov



Chest. 2005;127(4):1296-1303. doi:10.1378/chest.127.4.1296
Text Size: A A A
Published online

Background: Recently, a short-course treatment using 60 daily doses of rifampin and pyrazinamide was recommended for latent tuberculosis (TB) infection (LTBI).

Study objectives: To determine the acceptability, tolerability, and completion of treatment.

Design: Observational cohort study.

Setting: Five county jails and TB outreach clinics for homeless populations in three cities.

Patients: Study staff enrolled 1,211 patients (844 inmates and 367 homeless persons).

Interventions: Sites used 60 daily doses of rifampin and pyrazinamide, an approved treatment regimen for LTBI.

Measurements: Types and frequency of drug-related adverse events and outcomes of treatment.

Results: Prior to treatment, 25 of 1,178 patients (2.1%) had a serum aminotransferase measurement at least 2.5 times the upper limit of normal. Patients who reported excess alcohol use in the past 12 months were more likely than other patients to have an elevated pretreatment serum aminotransferase level (odds ratio, 2.1; 95% confidence interval, 1.1 to 6.1; p = 0.03). Treatment was stopped in 66 of 162 patients (13.4%) who had a drug-related adverse event. Among 715 patients who had serum aminotransferase measured during treatment, 43 patients (6.0%) had an elevation > 5 times the upper limits of normal, including one patient who died of liver failure attributed to treatment. In multivariate analyses, increasing age, an abnormal baseline aspartate aminotransferase level, and unemployment within the past 24 months were independent risk factors for hepatotoxicity. Completion rates were similar in jail inmates (47.5%) and homeless persons (43.6%).

Conclusions: This study detected the first treatment-associated fatality with the rifampin and pyrazinamide regimen, prompting surveillance that detected unacceptable levels of hepatotoxicity and retraction of recommendations for its routine use. Completion rates for LTBI treatment using a short-course regimen exceeds historical rates using isoniazid. Efforts to identify an effective short-course treatment for LTBI should be given a high priority.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543