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Guidelines of tuberculosis preventive therapy for HIV-infected persons: a prospective, multicentre study

¹ Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive L. Spallanzani -IRCCS, Rome, Italy, ² Programme on Communicable Diseases, World Health Organization, Geneva, Switzerland, ³ Clinica di Malattie Infettive, Policlinico di Bari, Bari, Italy, ⁴ Divisione di Malattie Infettive, Ospedale Cotugno, Napoli, Italy, ⁵ Divisione di Malattie Infettive, Ospedale S. Martino, Genova, Italy and ⁶ Divisione di Malattie Infettive, Ospedali Riuniti, Bergamo, Italy

CORRESPONDENCE: E. Girardi, Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive "L. Spallanzani" -IRCCS, Via Portuense, 292, 00149, Roma, Italy. Fax: 39 065582825

Keywords: cohort study, epidemiology, isoniazid preventive therapy, national guidelines, tuberculin reactivity, tuberculosis

Received: October 9, 2000
Accepted March 14, 2001

This work was financially supported by Ministero della Sanità-Progetto AIDS, and Fondi per la Ricerca Corrente degli IRCCS.

The aim of this study was to assess the degree of implementation of national guidelines for isoniazid preventive therapy (IPT) among human immunodeficiency virus (HIV)-infected individuals and factors affecting the impact of the programme.

Twenty-eight infectious disease hospital units in Italy participated in this observational, multicentre, prospective cohort study. A number of HIV-infected subjects, (n=1,705) seen for the first time as outpatients, were included in this analysis.

Of the subjects considered, 1,215 out of the 1,705 completed purified protein derivative (PPD) screening. Variables independently associated with offering and completion of PPD screening included having acquired immune deficiency syndrome (AIDS), higher educational levels and currently receiving therapy. Overall, 103 subjects were identified as candidates for IPT. Of these subjects, five had tuberculosis and 15 had contraindications to IPT. Forty subjects agreed to start IPT, and 29 completed a full-course regimen. The incidence of tuberculosis among IPT candidates who either did not begin or discontinued IPT was 6.1 per 100 person-yrs, while no cases of tuberculosis were observed in subjects completing IPT.

Several factors may limit the implementation of an isoniazid preventive therapy programme for human immunodeficiency virus-infected persons. Physicians fail to offer purified protein derivative screening to patients with high degrees of immunodeficiency, and those with a more intense workload seem to pay less attention to this test. The high number of contraindications among patients and their low level of acceptance further affects the impact of isoniazid preventive therapy.

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