569
document
Isoniazid prophylaxis for tuberculosis in HIV infection : a meta-analysis of randomized controlled trials . OBJECTIVES To evaluate the efficacy of isoniazid for the prevention of tuberculosis in tuberculin skin test-positive and negative individuals with HIV infection . DESIGN Meta-analysis of randomized controlled trials . SETTING Seven trials from Mexico , Haiti , the United States , Zambia , Uganda and Kenya . PATIENTS Individuals free from tuberculosis , 2367 persons in the intervention and 2162 in the control groups . INTERVENTION Comparison of isoniazid with placebo or no prophylaxis . METHODS A systematic search of the literature was carried out from 1985 to October 1997 for randomized controlled trials of isoniazid prophylaxis in HIV-infected persons . Two reviewers evaluated the relevance of each candidate study and the validity of eligible trials . Studies were pooled using a random effect model , conducting secondary analyses for tuberculin skin test-positive and negative persons . RESULTS Mean follow-up in trials varied between 0.4 and 3.2 years . Pooling all seven trials , a risk ratio was found for persons treated with isoniazid for developing tuberculosis of 0.58 [ 95 % confidence interval ( CI ) , 0.43-0.80 ] and 0.94 ( 95 % CI , 0.83-1.07 ) for death . In groups of tuberculin skin test-positive and negative persons , the risk ratio of tuberculosis was 0.40 ( 95 % CI , 0.24-0.65 ) and 0.84 ( 95 % CI , 0.54-1.30 ) , respectively , and the difference in the effectiveness of isoniazid versus placebo between these groups was statistically significant ( P = 0.03 , for the difference of summary estimates ) . Consistency of results was found across trials ( P > 0.10 , heterogeneity value ) for all comparisons . CONCLUSIONS Prophylaxis with isoniazid reduces the risk of tuberculosis in persons with HIV infection . The effect is restricted to tuberculin skin test-positive persons .
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Intervention_Pharmacological
isoniazid
571
Intervention_Pharmacological
isoniazid
572
Intervention_Control
placebo
573
Intervention_Pharmacological
isoniazid
574
Intervention_Pharmacological
isoniazid
575
Intervention_Pharmacological
isoniazid
576
Intervention_Control
placebo
577
Intervention_Pharmacological
isoniazid
578
Outcome_Other
risk ratio
579
Outcome_Mortality
death
580
Outcome_Other
risk ratio of tuberculosis
581
Outcome_Other
difference in the effectiveness
582
Participant_Condition
tuberculosis in HIV infection :