Short-course prophylaxis against tuberculosis in HIV-infected persons. A decision and cost-effectiveness analysis

Area of Science:

• Public Health
• Infectious Disease Management
• HIV/AIDS Care

Background:

• Isoniazid prophylaxis (12 months) is effective in preventing tuberculosis (TB) in HIV-infected persons, potentially reducing other HIV-related illnesses and mortality.
• Recent trials suggest that short-course TB prophylaxis regimens can also be effective.

Purpose of the Study:

• To compare the benefits, risks, and cost-effectiveness of standard 12-month isoniazid prophylaxis versus various short-course prophylaxis regimens.
• To evaluate the impact on survival rates, life expectancy, TB incidence, and economic outcomes.

Main Methods:

• Decision and cost-effectiveness analysis conducted in the United States.
• Modeled hypothetical HIV-infected patients with CD4 counts ≤200 cells/mm³ and positive tuberculin skin tests.
• Compared 12-month isoniazid prophylaxis with six short-course regimens (isoniazid, rifampin, pyrazinamide alone or in combination).

Main Results:

• The 12-month isoniazid regimen increased 5-year survival by 9%, life expectancy by 8.7 months, and reduced TB incidence by 27%, with a 4:1 cost savings ratio.
• Several short-course regimens (e.g., 6-month isoniazid, 3-month isoniazid/rifampin, 2-month rifampin/pyrazinamide) showed comparable improvements in life expectancy and TB reduction, with cost savings of 1:1 to 7:1.
• A 3-month isoniazid, rifampin, and pyrazinamide regimen offered fewer clinical benefits and was not cost-saving.

Conclusions:

• Tuberculosis prophylaxis significantly decreases TB incidence and increases life expectancy in HIV-infected patients.
• Certain short-course prophylaxis regimens provide clinical and economic benefits comparable to the 12-month isoniazid regimen.
• Short-course prophylaxis represents a viable and effective alternative to the standard 12-month isoniazid regimen for TB prevention in this population.