Comparison of 3 Preventive Tuberculosis Therapies in Patients With HIV Infection

Close up of different pills for the hiv infection treatment.
Close up of different pills for the hiv infection treatment. PrEP Pills for Pre-Exposure Prophylaxis to help protect people from HIV.
Researchers conducted a randomized trial that compared the effects of 3 treatment regimens for the prevention of tuberculosis infection among individuals with HIV infection currently taking antiretroviral therapy.

Among individuals with HIV infection currently taking antiretroviral therapy (ART), self-administered preventive tuberculosis (TB) therapy with a 3-month course of rifapentine and isoniazid was found to be associated with a significantly increased rate of treatment completion compared with a 6-month course of isoniazid alone, according to results of a study published in Annals of Internal Medicine. Moreover, an additional round of short-course preventive therapy 1 year later provided no additional benefit nor did it decrease TB incidence in populations with high transmission and ART uptake.

Between November 2016 and November 2017, researchers conducted a parallel open-label randomized trial to compare the effects of 3 treatment regimens for the prevention of TB in participants with HIV infection currently taking ART. A total of 4014 patients in South Africa, Ethiopia, and Mozambique, who were aged 2 years and older without active TB, were included in the final analysis. Participants were randomly assigned to receive either weekly treatment with rifapentine and isoniazid for 3 months (given either once annually for 2 years or 1), or daily isoniazid alone for 6 months. Participants were screened for tuberculosis at baseline and months 3 and 12 for each year of the study, and chest x-rays and sputum cultures were obtained at months 12 and 24. The researchers used pill counts to assess the rate of treatment completion, and they measured TB incidence rates during a 24-month period.

Among the included in the analysis, the mean age was 41 years, 69.5% were women, and all were currently taking ART. Treatment completion rates after the first year were 90.4% (n=3610) among patients taking both rifapentine and isoniazid vs 50.5% (n=404) among those taking isoniazid alone (risk ratio, 1.78;95% CI, 1.61-1.95). The researchers found that incidence rates of TB between participants treated with a 3-month regimen of rifapentine and isoniazid once yearly for 1 year (n=1802) vs those treated with the same regimen once yearly for 2 years (n=1808) were similar (hazard ratio, 0.96; 95% CI, 0.61-1.50).

The study was limited by its pragmatic design and the potential inclusion of participants with active TB due to the use of an outdated TB screen (2011 World Health Organization 4-symptom screen) which had a sensitivity of 53%.

The researchers noted that “if rifapentine-isoniazid is effective in curing subclinical [TB], then intensive [TB] screening at month 12 may have [decreased] its effectiveness; however, it would not undermine the effectiveness of rifapentine-isoniazid in treating TB infection.”


Churchyard G, Cárdenas V, Chihota V, Mngadi K, et al. Annual tuberculosis preventive therapy for persons with hiv infection:A randomized trial. Ann Intern Med. Published online August 24, 2021. doi:10.7326/M20-7577

This article originally appeared on Infectious Disease Advisor