Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis
T. J. Jordan, E. M. Lewit, R. L. Montgomery and L. B. Reichman
Division of Informatics, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark 07103-2406.
Tuberculin skin testing is a notoriously poor marker of tuberculosis
infection in patients who are serologically positive for the human
immunodeficiency virus. A decision analysis was performed to determine if
and when isoniazid should be prescribed to prevent tuberculosis in these
patients. The decision was analyzed for an intravenous drug abuser who may
have been anergic, while tuberculin test status, race, and gender were
varied. The assumptions and parameter estimates selected for this
investigation represent a highly conservative vantage point opposing the
use of isoniazid as a preventive therapy. Nevertheless, results showed a
benefit from the use of isoniazid as a preventive therapy for all groups,
even without tuberculin testing, except tuberculin-negative black women.
This benefit of isoniazid therapy increased patient life expectancy as much
as 285 days. Further, the decisions continue to favor prescribing isoniazid
even when the suspected incidence of tuberculosis infection falls as low as
3% to 8%. Tuberculin testing appears important primarily for black women,
since those who have negative tuberculin skin tests may not be candidates
for isoniazid therapy.
Enhancement of Treatment Completion for Latent Tuberculosis Infection With 4 Months of Rifampin
Lardizabal et al.
Chest 2006;130:1712-1717.
ABSTRACT
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Considering the Role of Four Months of Rifampin in the Treatment of Latent Tuberculosis Infection
Reichman et al.
Am. J. Respir. Crit. Care Med. 2004;170:832-835.
FULL TEXT
Treatment Completion and Costs of a Randomized Trial of Rifampin for 4 Months versus Isoniazid for 9 Months
Menzies et al.
Am. J. Respir. Crit. Care Med. 2004;170:445-449.
ABSTRACT
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Tuberculosis Prevention in Methadone Maintenance Clinics . Effectiveness and Cost-Effectiveness
SNYDER et al.
Am. J. Respir. Crit. Care Med. 1999;160:178-185.
ABSTRACT
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Preventive Therapy for Tuberculosis in HIV-Infected Persons: Analysis of Policy Options Based on Tuberculin Status and CD4+Cell Count
Sawert et al.
Arch Intern Med 1998;158:2112-2121.
ABSTRACT
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Skin Anergy Testing and Tuberculosis Surveillance
Lincoln et al.
JOURNAL OF CORRECTIONAL HEALTH CARE 1997;4:139-153.
ABSTRACT
Tuberculosis, AIDS, and Death among Substance Abusers on Welfare in New York City
Friedman et al.
NEJM 1996;334:828-833.
ABSTRACT
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