Document 0707
 DOCN  M95A0707
 TI    Isoniazid preventive therapy in areas of high isoniazid resistance.
 DT    9510
 AU    Sterling TR; Brehm WT; Frieden TR; Department of Medicine, Keesler
       Medical Center, Keesler AFB,; Miss., USA.
 SO    Arch Intern Med. 1995 Aug 7-21;155(15):1622-8. Unique Identifier :
       AIDSLINE MED/95344294
 AB    BACKGROUND: Previous decision analyses of isoniazid preventive therapy
       for low-risk tuberculin reactors aged 20 to 34 years have not accounted
       for the recently increased isoniazid resistance rate. Drug resistance
       trends could also affect the decision to use isoniazid preventive
       therapy for patients with recent conversion of tuberculin skin tests who
       are seronegative for human immunodeficiency virus. METHODS: A decision
       analysis was performed with a Markov simulation to assess the difference
       in life expectancy between those who receive isoniazid preventive
       therapy and those who do not. Probability estimates were determined from
       a review of the literature. RESULTS: For tuberculin reactors aged 20 to
       34 years living in areas with 26% isoniazid resistance, isoniazid
       preventive therapy increases life expectancy by 2 days. Withholding
       isoniazid is clearly favored if the isoniazid hepatitis rate is 1.1% and
       the hepatitis fatality rate exceeds 2.8%. For recent tuberculin
       converters, isoniazid preventive therapy increases life expectancy by 14
       to 17 days, depending on patient age. Withholding isoniazid from
       converters is favored only if the isoniazid resistance rate exceeds 90%
       to 98%, according to patient age. Two-way sensitivity analysis of
       isoniazid-associated hepatitis and hepatitis-related fatality rate did
       not affect the decision to use isoniazid for recent converters.
       CONCLUSIONS: For tuberculin reactors aged 20 to 34 years who are
       seronegative for human immunodeficiency virus and living in areas with
       high isoniazid resistance, there is minimal net benefit of isoniazid
       preventive therapy. The current recommendation to provide isoniazid
       preventive therapy to this patient population should be reexamined. For
       recent tuberculin converters aged 20 to 64 years who are seronegative
       for human immunodeficiency virus, isoniazid preventive therapy provides
       a small increase in life expectancy. Withholding isoniazid preventive
       therapy for human immunodeficiency virus-seronegative skin test
       converters at high risk for isoniazid-induced hepatitis may be
       considered; preventive therapy is advisable for all other recent
       converters.
 DE    Adult  Age Factors  Drug Resistance, Microbial  Female  Hepatitis,
       Toxic/ETIOLOGY  Human  Isoniazid/ADVERSE EFFECTS/*THERAPEUTIC USE  Male
       Middle Age  Sensitivity and Specificity  Tuberculin Test  Tuberculosis,
       Pulmonary/DIAGNOSIS/*PREVENTION & CONTROL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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