Rose D N
Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA.
Ann Intern Med. 1998 Nov 15;129(10):779-86. doi: 10.7326/0003-4819-129-10-199811150-00005.
Isoniazid prophylaxis for 12 months effectively prevents tuberculosis in HIV-infected persons and may decrease the incidence of other HIV-related disease and mortality. Recent clinical trials have found that some short-course regimens also effectively prevent tuberculosis.
To compare the benefits, risks, and cost-effectiveness of isoniazid prophylaxis and short-course prophylaxis regimens.
Decision and cost-effectiveness analysis.
United States.
Hypothetical patients who are HIV-infected and have CD4 counts of 200 cells/mm3 or less and positive results on tuberculin skin tests.
Isoniazid prophylaxis lasting 12 months and six short-course prophylaxis regimens of isoniazid, rifampin, and pyrazinamide alone or in combination.
5-year survival rate, life expectancy, lifetime incidence of tuberculosis, and cost per quality-adjusted life-year saved.
Compared with no prophylaxis, the 12-month isoniazid regimen increased 5-year survival rates by 9% and life expectancy by 8.7 months, decreased incidence of tuberculosis by 27%, and saved 4 medical care dollars for every 1 spent on prophylaxis. Regimens of isoniazid for 6 months, isoniazid and rifampin for 3 months, and rifampin and pyrazinamide for 2 months had similar results: 6.2- to 8.6-month increases in life expectancy, 19% to 26% reductions in incidence of tuberculosis, and 1 to 7 medical care dollars saved for every 1 spent on prophylaxis. A 3-month regimen of isoniazid, rifampin, and pyrazinamide resulted in fewer clinical benefits and was the only regimen tested that did not save medical care dollars.
Prophylaxis decreases the incidence of tuberculosis and increases life expectancy for HIV-infected patients. Some regimens save medical care dollars, and some short-course regimens have clinical and economic benefits similar to those of the 12-month isoniazid regimen. Short-course prophylaxis is a reasonable alternative to the 12-month isoniazid regimen.
对感染HIV的患者进行12个月的异烟肼预防性治疗可有效预防结核病，并可能降低其他与HIV相关疾病的发病率和死亡率。最近的临床试验发现，一些短程治疗方案也能有效预防结核病。
比较异烟肼预防性治疗和短程预防性治疗方案的益处、风险及成本效益。
决策和成本效益分析。
美国。
假设为感染HIV且CD4细胞计数为200个/立方毫米或更低、结核菌素皮肤试验结果呈阳性的患者。
持续12个月的异烟肼预防性治疗，以及六种异烟肼、利福平、吡嗪酰胺单独或联合使用的短程预防性治疗方案。
5年生存率、预期寿命、结核病终身发病率以及每挽救一个质量调整生命年的成本。
与不进行预防性治疗相比，为期12个月的异烟肼治疗方案使5年生存率提高了9%，预期寿命延长了8.7个月，结核病发病率降低了27%，且每投入1美元用于预防性治疗可节省4美元的医疗费用。为期6个月的异烟肼治疗方案、为期3个月的异烟肼和利福平联合治疗方案以及为期2个月的利福平和吡嗪酰胺联合治疗方案均有类似结果：预期寿命延长6.2至8.6个月，结核病发病率降低19%至26%，每投入1美元用于预防性治疗可节省1至7美元的医疗费用。为期3个月的异烟肼、利福平和吡嗪酰胺联合治疗方案带来较少的临床益处，是所测试的唯一未节省医疗费用的方案。
预防性治疗可降低感染HIV患者的结核病发病率并延长预期寿命。一些治疗方案可节省医疗费用，一些短程治疗方案具有与为期12个月的异烟肼治疗方案相似的临床和经济效益。短程预防性治疗是为期12个月的异烟肼治疗方案的合理替代方案。
