Daily vs Intermittent TB Treatment in HIV: Which Is Better?

Daily anti-tuberculosis (TB) therapy is superior to intermittent therapy in antiretroviral-treated patients with human immunotherapy virus (HIV) with pulmonary TB, according to a recent study.

From September 14, 2009, to January 18, 2016, researchers assessed 331 adults with HIV with newly diagnosed, culture-positive, pulmonary TB.
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Participants were randomly assigned to daily (n = 98), part-daily (n = 96), or intermittent anti-TB therapy (n = 98) and were classified by baseline cluster of differentiation 4 (CD4) lymphocyte count and sputum smear grade. Monthly clinical and sputum microbiological examinations of patients were performed for 18 months.

Results indicated that favorable responses occurred in 91%, 80%, and 77% of patients treated with daily, part-daily, and intermittent regiments, respectively.

Notably, the difference in outcome between daily and intermittent regimens crossed the O’Brien-Fleming group sequential boundaries and led to rifampicin resistance emergence in 4 patients in the intermittent therapy group. As a result, the data safety monitoring committee halted the study.

The researchers noted that 18 patients died and 18 patients dropped out of the trial during the treatment period. In addition, 6 patients receiving daily treatment, 4 patients receiving part-daily treatment, and 6 patients receiving intermittent treatment had TB recurrence.

“Among HIV-positive patients with pulmonary TB receiving antiretroviral therapy, a daily anti-TB regimen proved superior to a thrice-weekly regimen in terms of efficacy and emergence of rifampicin resistance,” the researchers concluded.

—Christina Vogt

Reference:

Gopalan N, Santhanakrishnan RK, Palaniappan AN, et al. Daily vs intermittent antituberculosis therapy for pulmonary tuberculosis in patients with HIV: a randomized clinical trial [Published online March 5, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.0141.