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Isoniazid Preventive Therapy in Areas of High Isoniazid Resistance

Isoniazid Preventive Therapy in Areas of High Isoniazid Resistance Abstract 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.(Arch Intern Med. 1995;155:1622-1628) References 1. Bloch AB, Rieder HL, Kelly GD, Cauthen GM, Hayden CH, Snider DE. The epidemiology of tuberculosis in the United States: implications for diagnosis and treatment. Clin Chest Med . 1989;10:297-313. 2. Jereb JA, Kelly GD, Dooley SW, Cauthen GM, Snider DE. Tuberculosis morbidity in the United States: final data, 1990. MMWR Morb Mortal Wkly Rep . 1992;40( (SS-3) ):23-27. 3. Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW. The emergence of drug-resistant tuberculosis in New York City. N Engl J Med . 1993;328:521-526.Crossref 4. Bloch AB, Cauthen GM, Onorato IM, et al. Nationwide survey of drug-resistant tuberculosis in the United States. JAMA . 1994;271:665-671.Crossref 5. Barnes PF, Bloch AB, Davidson PT, Snider DE. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med . 1991;324:1644-1650.Crossref 6. Weinstein MC, Fineberg HV. Clinical Decision Analysis . Philadelphia, Pa: WB Saunders Co; 1980. 7. Pauker SG, Kassirer JP. Decision analysis. N Engl J Med . 1987;316:250-258.Crossref 8. Tsevat J, Taylor WC, Wong JB, Pauker SG. Isoniazid for the tuberculin reactor: take it or leave it. Am Rev Respir Dis . 1988;137:215-220.Crossref 9. Rose DN, Schechter CB, Silver AL. The age threshold for isoniazid chemoprophylaxis: a decision analysis for low-risk tuberculin reactors. JAMA . 1986;256: 2709-2713.Crossref 10. Taylor WC, Aronson MD, Delbanco TL. Should young adults with a positive tuberculin test take isoniazid? Ann Intern Med . 1981;94:808-813.Crossref 11. Comstock GW, Edwards PQ. The competing risks of tuberculosis and hepatitis for adult tuberculin reactors. Am Rev Respir Dis . 1975;111:573-577. 12. Colice GL. Decision analysis, public health policy, and isoniazid chemoprophylaxis for young adult tuberculin skin reactors. Arch Intern Med . 1990;150: 2517-2522.Crossref 13. Centers for Disease Control and Prevention. The use of preventive therapy for tuberculosis infection in the United States: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR Morb Mortal Wkly Rep . 1990;39( (RR-8) ):9-12. 14. American Thoracic Society. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med . 1994;149:1359-1374.Crossref 15. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh R Jr. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med . 1993;328:527-532.Crossref 16. Snider DE Jr, Caras GJ. Isoniazid-associated hepatitis deaths: a review of available information. Am Rev Respir Dis . 1992;145:494-497.Crossref 17. Koplan JP, Farer LS. Choice of preventive treatment for isoniazid-resistant tuberculous infection: use of decision analysis and the Delphi technique. JAMA . 1980;244:2736-2740.Crossref 18. Selwyn PA, Sckell BM, Alcabes P, Friedland GH, Klein RS, Schoenbaum EE. High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy. JAMA . 1992;268:504-509.Crossref 19. Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making . 1983;3:419-458.Crossref 20. Sonnenberg FA, Pauker SG. Decision Maker Version 7.0 . Boston, Mass: New England Medical Center; 1993. 21. International Union Against Tuberculosis. Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. Bull WHO . 1982;60:555-564. 22. Kopanoff DE, Snider DE Jr, Caras GJ. Isoniazid-related hepatitis: a U.S. Public Health Service Cooperative Surveillance Study. Am Rev Respir Dis . 1978;117: 991-1001. 23. Dash LA, Comstock GW, Flynn JPG. Isoniazid preventive therapy. Am Rev Respir Dis . 1980;121:1039-1044. 24. Byrd RB, Horn BR, Solomon DA, Griggs GA. Toxic effects of isoniazid in tuberculosis chemoprophylaxis. JAMA . 1979;241:1239-1241.Crossref 25. Snider DE Jr, Cauthen GM, Farer LS, et al. Drug-resistant tuberculosis. Am Rev Respir Dis . 1991;144:732.Crossref 26. Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis: a general review. Adv Tuberc Res . 1970:17:29-106. 27. Snider DE Jr. Decision analysis for isoniazid preventive therapy: take it or leave it? Am Rev Respir Dis . 1988;137:2-4.Crossref 28. DesPrez RM, Heim CR. Mycobacterium tuberculosis. In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases . 3rd ed. New York, NY: John Wiley & Sons Inc; 1990:1881. 29. Sutherland I. Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli. Adv Tuberc Res . 1976;19:1-63. 30. Centers for Disease Control. Tuberculosis Statistics: States and Cities, 1985 . Atlanta, Ga: Centers for Disease Control; November 1986. Dept of Health and Human Services publication (CDC)87-8249. 31. Joint Report of Hong Kong Chest Service and British Medical Research Council survey of deaths in Hong Kong attributed to tuberculosis during a five-year period. Tubercle . 1984;65:253-261.Crossref 32. Jereb JA, Cauthen GM, Kelly GD, Geiter LJ. The epidemiology of tuberculosis. In: Friedman LN, ed. Tuberculosis: Current Concepts and Treatment . Boca Raton, Fla: CRC Press; 1994:15-16. 33. National Center for Health Statistics. Vital Statistics of the United States, 1989 . Washington, DC: Public Health Service; 1989. Dept of Health and Human Services publication (PHS)92-1102. 34. Snider DE Jr, Long MW, Cross FS, Farer LS. Six-months isoniazid-rifampin therapy for pulmonary tuberculosis. Am Rev Respir Dis . 1984;129:573-579. 35. Steele MA, Burk RF, DesPrez RM. Toxic hepatitis with isoniazid and rifampin: a meta-analysis. Chest . 1991;99:465-471.Crossref 36. Tsevat J, Weinstein MC, Williams LW, Tosteson ANA, Goldman L. Expected gains in life expectancy from various coronary heart disease risk factor modifications. Circulation . 1991;83:1194-1201.Crossref 37. Moulding TS, Redeker AG, Kanel GC. Twenty isoniazid-associated deaths in one state. Am Rev Respir Dis . 1989;140:700-705.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Isoniazid Preventive Therapy in Areas of High Isoniazid Resistance

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430150096010
Publisher site
See Article on Publisher Site

Abstract

Abstract 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.(Arch Intern Med. 1995;155:1622-1628) References 1. Bloch AB, Rieder HL, Kelly GD, Cauthen GM, Hayden CH, Snider DE. The epidemiology of tuberculosis in the United States: implications for diagnosis and treatment. Clin Chest Med . 1989;10:297-313. 2. Jereb JA, Kelly GD, Dooley SW, Cauthen GM, Snider DE. Tuberculosis morbidity in the United States: final data, 1990. MMWR Morb Mortal Wkly Rep . 1992;40( (SS-3) ):23-27. 3. Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen GM, Dooley SW. The emergence of drug-resistant tuberculosis in New York City. N Engl J Med . 1993;328:521-526.Crossref 4. Bloch AB, Cauthen GM, Onorato IM, et al. Nationwide survey of drug-resistant tuberculosis in the United States. JAMA . 1994;271:665-671.Crossref 5. Barnes PF, Bloch AB, Davidson PT, Snider DE. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med . 1991;324:1644-1650.Crossref 6. Weinstein MC, Fineberg HV. Clinical Decision Analysis . Philadelphia, Pa: WB Saunders Co; 1980. 7. Pauker SG, Kassirer JP. Decision analysis. N Engl J Med . 1987;316:250-258.Crossref 8. Tsevat J, Taylor WC, Wong JB, Pauker SG. Isoniazid for the tuberculin reactor: take it or leave it. Am Rev Respir Dis . 1988;137:215-220.Crossref 9. Rose DN, Schechter CB, Silver AL. The age threshold for isoniazid chemoprophylaxis: a decision analysis for low-risk tuberculin reactors. JAMA . 1986;256: 2709-2713.Crossref 10. Taylor WC, Aronson MD, Delbanco TL. Should young adults with a positive tuberculin test take isoniazid? Ann Intern Med . 1981;94:808-813.Crossref 11. Comstock GW, Edwards PQ. The competing risks of tuberculosis and hepatitis for adult tuberculin reactors. Am Rev Respir Dis . 1975;111:573-577. 12. Colice GL. Decision analysis, public health policy, and isoniazid chemoprophylaxis for young adult tuberculin skin reactors. Arch Intern Med . 1990;150: 2517-2522.Crossref 13. Centers for Disease Control and Prevention. The use of preventive therapy for tuberculosis infection in the United States: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR Morb Mortal Wkly Rep . 1990;39( (RR-8) ):9-12. 14. American Thoracic Society. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med . 1994;149:1359-1374.Crossref 15. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh R Jr. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med . 1993;328:527-532.Crossref 16. Snider DE Jr, Caras GJ. Isoniazid-associated hepatitis deaths: a review of available information. Am Rev Respir Dis . 1992;145:494-497.Crossref 17. Koplan JP, Farer LS. Choice of preventive treatment for isoniazid-resistant tuberculous infection: use of decision analysis and the Delphi technique. JAMA . 1980;244:2736-2740.Crossref 18. Selwyn PA, Sckell BM, Alcabes P, Friedland GH, Klein RS, Schoenbaum EE. High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy. JAMA . 1992;268:504-509.Crossref 19. Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making . 1983;3:419-458.Crossref 20. Sonnenberg FA, Pauker SG. Decision Maker Version 7.0 . Boston, Mass: New England Medical Center; 1993. 21. International Union Against Tuberculosis. Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. Bull WHO . 1982;60:555-564. 22. Kopanoff DE, Snider DE Jr, Caras GJ. Isoniazid-related hepatitis: a U.S. Public Health Service Cooperative Surveillance Study. Am Rev Respir Dis . 1978;117: 991-1001. 23. Dash LA, Comstock GW, Flynn JPG. Isoniazid preventive therapy. Am Rev Respir Dis . 1980;121:1039-1044. 24. Byrd RB, Horn BR, Solomon DA, Griggs GA. Toxic effects of isoniazid in tuberculosis chemoprophylaxis. JAMA . 1979;241:1239-1241.Crossref 25. Snider DE Jr, Cauthen GM, Farer LS, et al. Drug-resistant tuberculosis. Am Rev Respir Dis . 1991;144:732.Crossref 26. Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis: a general review. Adv Tuberc Res . 1970:17:29-106. 27. Snider DE Jr. Decision analysis for isoniazid preventive therapy: take it or leave it? Am Rev Respir Dis . 1988;137:2-4.Crossref 28. DesPrez RM, Heim CR. Mycobacterium tuberculosis. In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases . 3rd ed. New York, NY: John Wiley & Sons Inc; 1990:1881. 29. Sutherland I. Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli. Adv Tuberc Res . 1976;19:1-63. 30. Centers for Disease Control. Tuberculosis Statistics: States and Cities, 1985 . Atlanta, Ga: Centers for Disease Control; November 1986. Dept of Health and Human Services publication (CDC)87-8249. 31. Joint Report of Hong Kong Chest Service and British Medical Research Council survey of deaths in Hong Kong attributed to tuberculosis during a five-year period. Tubercle . 1984;65:253-261.Crossref 32. Jereb JA, Cauthen GM, Kelly GD, Geiter LJ. The epidemiology of tuberculosis. In: Friedman LN, ed. Tuberculosis: Current Concepts and Treatment . Boca Raton, Fla: CRC Press; 1994:15-16. 33. National Center for Health Statistics. Vital Statistics of the United States, 1989 . Washington, DC: Public Health Service; 1989. Dept of Health and Human Services publication (PHS)92-1102. 34. Snider DE Jr, Long MW, Cross FS, Farer LS. Six-months isoniazid-rifampin therapy for pulmonary tuberculosis. Am Rev Respir Dis . 1984;129:573-579. 35. Steele MA, Burk RF, DesPrez RM. Toxic hepatitis with isoniazid and rifampin: a meta-analysis. Chest . 1991;99:465-471.Crossref 36. Tsevat J, Weinstein MC, Williams LW, Tosteson ANA, Goldman L. Expected gains in life expectancy from various coronary heart disease risk factor modifications. Circulation . 1991;83:1194-1201.Crossref 37. Moulding TS, Redeker AG, Kanel GC. Twenty isoniazid-associated deaths in one state. Am Rev Respir Dis . 1989;140:700-705.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 7, 1995

References