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Daily vs Intermittent Antituberculosis Therapy for Pulmonary Tuberculosis in Patients With HIV: A Randomized Clinical
Narendran Gopalan1, Ramesh Kumar Santhanakrishnan1, Alangudi Natarajan Palaniappan1
1National Institute for Research in Tuberculosis, Chennai, India.
JAMA Internal Medicine
|March 7, 2018
Summary
Daily antituberculosis therapy is more effective and safer than intermittent regimens for HIV-positive patients on antiretroviral therapy. This approach reduces treatment failures and the emergence of drug resistance in pulmonary tuberculosis.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Medicine
Background:
- HIV-positive individuals with pulmonary tuberculosis (TB) require effective treatment regimens.
- The optimal dosing schedule for antituberculosis therapy in patients receiving antiretroviral therapy (ART) remains under investigation.
Purpose of the Study:
- To compare the efficacy and safety of daily, part-daily, and intermittent antituberculosis therapy regimens.
- To evaluate treatment outcomes in HIV-associated pulmonary TB patients receiving ART.
Main Methods:
- An open-label, randomized clinical trial involving adults with HIV and newly diagnosed pulmonary TB.
- Patients were randomized to daily, part-daily, or intermittent antituberculosis therapy, with ART initiated per national guidelines.
Main Results:
- A daily regimen showed a higher favorable response rate (91%) compared to part-daily (80%) and intermittent (77%) regimens.
- The study was halted due to superior efficacy of the daily regimen and the emergence of rifampicin resistance exclusively in the intermittent group.
Conclusions:
- Daily antituberculosis therapy is superior to thrice-weekly regimens for HIV-positive patients on ART.
- Daily regimens improve treatment efficacy and reduce the risk of drug resistance in pulmonary TB management.
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