Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials
Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials
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DOI：
10.1097/00002030-199903110-00009
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发表时间：
1999-03-11
期刊：
影响因子：
3.8
通讯作者：
Battegay, M
中科院分区：
文献类型：
--
作者：
Bucher, HC;Griffith, LE;Battegay, M
目的：评价异烟肼预防结核菌素皮肤试验阳性和阴性HIV感染者结核病的疗效。设计：随机对照试验荟萃分析。环境：来自墨西哥、海地、美国、赞比亚、乌干达和肯尼亚的七个试验。患者：无结核病患者，干预组2367人，对照组2162人。干预：异烟肼与安慰剂或无预防的比较。方法：系统检索1985年至1997年10月间关于异烟肼预防hiv感染者的随机对照试验的文献。两名审稿人评估了每个候选研究的相关性和符合条件的试验的有效性。研究采用串联效应模型进行汇总，对结核菌素皮肤试验阳性和阴性的人进行二次分析。结果：试验的平均随访时间在0.4年到3.2年之间。综合所有7项试验，发现接受异烟肼治疗的患者发生结核病的风险比为0.58[95%可信区间（CI）， 0.33-0.80]，死亡风险比为0.94 （95% CI, 0.83-1.07）。结核菌素皮肤试验阳性组和阴性组中，结核病的风险比分别为0.40 （95% CI, 0.24-0.65）和0.84 (95% CI, 0.54-1.30)，两组间异烟肼与安慰剂的疗效差异有统计学意义（P = 0.03，为总估计的差异）。在所有比较中，各试验结果一致（P < 0.10，异质性值）。结论：异烟肼预防可降低HIV感染者患结核病的风险。这种效果仅限于结核菌素皮肤试验阳性的人。(C) 1999 Lippincott Williams & Wilkins。
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 tandem 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), 0.33-0.80] 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. (C) 1999 Lippincott Williams & Wilkins.