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New York Times
Pill Can Prevent Fatal TB in H.I.V. Patients

<p>Donald G. McNeil Jr.</p>


August 20, 2013

An inexpensive daily pill can often fend off a lethal bout of tuberculosis in people with H.I.V., according to a large new study.

The drug is isoniazid, a generic antibiotic, and the World Health Organization has recommended a daily dose since 1998 for H.I.V. patients who harbor germs for tuberculosis but have no symptoms; full-blown TB is a leading killer of AIDS victims. But public health doctors in poor countries rarely bother.

“It’s a combination of ignorance, fear of creating antibiotic resistance and a belief among many TB doctors that it won’t work,” said Dr. Richard E. Chaisson, a tuberculosis specialist at The Johns Hopkins University School of Medicine who led the research.

The study, published last week by Lancet Infectious Disease, found that a daily isoniazid pill reduced deaths and active TB cases by 31 percent among 12,816 patients at 29 Brazilian clinics. In patients whose urine samples proved that they actually took their pills regularly, Dr. Chaisson added, the effect was far greater — a reduction of about 80 percent.

Side effects were minor, and of the patients who developed TB despite taking the pill, none got an isoniazid-resistant form of the disease. So the concern about drug resistance is unfounded, Dr. Chaisson said. Patients who were already taking three to six daily pills for their H.I.V. were usually willing to take one more.

An editorial accompanying the study looked at several isoniazid trials and said the antibiotic worked, but only when public clinics could test patients correctly, provide pills steadily and make sure they were taken.



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