Re: E-DRUG: INH Prophylaxis in HIV

[Dave <psycho@merlin.net.au>]

E-DRUG: INH Prophylaxis in HIV (cont)
------------------------------------

>B. Ekbal scribbled:
>"A few experts argue very strongly that all HIV positive cases should 
> receive INH prophylaxis to prevent the development of tuberculosis"

Acknowledging differences in clinical practice around the globe, a good
place to start nonetheless is the "1997 USPHS/IDSA Guidelines for the
Prevention of Opportunistic Infections in Persons Infected with the Human
Immunodeficiency Virus" published by the US CDC (MMWR Recommendations and
Reports 1997 Vol 46 No. RR-12). As far as I am aware (from my brief
extravaganza as a clinical pharmacist in HIV medicine) the practice in
Australia is pretty much consistent with their recommendations. The summary
of the recommendations I have attached below, the full text can be
downloaded from
ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4612.pdf (assumming you have
an Adobe Acrobat Reader)

Cheers,
David Ng, BPharm MClinPharm
Pharmacist
Adelaide, Australia
E-mail: psycho@merlin.net.au

----------

TUBERCULOSIS
Prevention of disease:

1. Patients should receive a Mantoux test when HIV infection is first
recognised.

2. Chest radiography should be performed if positive test of > 5mm for the
exclusion of active disease. Those with symptoms suggestive of TB should
undergo chest radiography regardless of Mantoux result.

3. All HIV infected persons with +'ve result with no evidence of active
disease and no history of prophylaxis or treatment for TB should receive 12
months of isoniazid (INH) and pyridoxine (to prevent neuropathy)

4. HIV infected persons with close contacts who have infectious TB should
receive preventative therapy regardless of Mantoux test results or prior
courses of chemoprophylaxis.
[All above recommendations have strong evidence to support them and should
always be offered with at least one properly controlled trial]

5. Test -'ve persons from risk groups or geographic areas with high
prevalence of M. tuberculosis are at increased risk and some experts
recommend prophylaxis for this group. However the efficacy of preventative
therapy for this group has not been demonstrated, and such prophylaxis
cannot be routinely recommended and must be considered individually [NB:
These guidelines were published in mid-1997, and HIV medicine progresses
very rapidly, so I am not sure if there is new evidence which suggests
otherwise] Quality of evidence for this particular recommendation: CIII =
evidence to support recommendation for or against use is insufficient, and
based on opinions of respected authorities based on clinical experience,
descriptive studies, or reports of expert committees.

 
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