Compliance with prophylaxis after TB Exposure in an HIV clinic

L. A. Grohskopf, J. Woodward, C. Glenn, K. Byun, T. M. Hooton

Research output: Contribution to journalArticle

Abstract

Post-exposure prophylaxis for tuberculosis (TB) is standard for HIV-infected persons, but poor compliance promotes emergence of drug-resistant TB. In 1994, a patient at our clinic was diagnosed with 4+ smear-positive pulmonary TB following 11 visits over 2.5 months for fever and cough. 223 pts. present during the same half-day sessions were considered exposed (mean=2.3 exposures, range 1-8). In addition to PPD/anergy tests and chest radiographs, isonlazid (INH), 300mg/d, or rifabutin (RIF) (if CD4 was 100) for 1 year was encouraged for all pts. unless the pt. refused, had active liver disease, currently abused ethanol or IV drugs, or had demonstrated poor compliance in the past. Compliance was assessed by the number of monthly refills picked up from the on-site pharmacy and was rated in 2 6-month periods as A (5-6 consecutive refills), B (2-4 consecutive refills), or C (2-4 non-consecutive refills). Pts. already on anti-TB drugs or using off-site pharmacies were excluded. 77 pts. began INH, 19 RIF and 2 rifampin (total=98). 14 were excluded from analysis of both periods (5 who died <6 months after starting therapy, 9 who stopped due to side effects) and 12 more were excluded for the 2nd 6-month period (died during 2nd 6 months of therapy). Percent compliance is summarized below. Of note, "A" compliance at 1 year was only 21%. Among all A n(%) B, B/B. A/B n(%) C or worse n(%) 1st 6 mo. (n=84) 32 (38) 11 (13) 41 (49) Both 6 mo. periods (n=72) 15 (21) 6(8) 51(71) exposed non-anergic pts. (n=30), 1 PPD conversion occurred (in a pt. with 6 exposures). Among all exposed pts., there have been no known cases of TB. We conclude that mass TB prophylaxis in an HIV clinic population is associated with very poor 12 month compliance. The resultant risk of drug resistance may outweigh the potential benefit of TB risk reduction.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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