Tuberculosis and HIV infection [letter]

Only a small amount of data exist related to the safety and efficacy of isoniazid prophylaxis against tuberculosis (TB) in HIV-1 infected individuals in migrant relief camps. 11000 Haitians were screened for HIV infection and active TB at the US naval base in Guantanamo Bay Cuba from November 1991 to June 1992 as part of their application to enter the US. Comprehensive medical care was given to a subpopulation of 287 individuals found to be infected with HIV. These individuals were held in a migrant camp for up to 19 months pending resolution of litigation. 28 presented clinical or radiological evidence of active TB supporting the need for treatment with standard anti-TB situation in which an estimated 67% of the migrant population were predicted to be purified protein derivative tuberculin (PPD)-positive and anergy testing was impractical. Four incident cases of active TB were recorded among the 259 after 224 person-years follow-up. One of these individuals had an M. tuberculosis isolate resistant to isoniazid and two admitted noncompliance with the prophylactic regime. No cases of isoniazid toxicity were found serious enough to discontinue therapy. The finding of 1.8 incident cases of TB per 100 person-years of follow-up on this isoniazid prophylaxis is similar to the 2.2 cases per 100 persons-years of follow-up reported by Pape and colleagues from their Haitian series and is definitely less than the 7.5 cases per 100 person-years of follow up reported for HIV-infected patients not treated with isoniazid. The data suggest that isoniazid is effective and safe when used for prophylaxis against TB among HIV-infected Haitians in a migrant camp setting. Isoniazid prophylaxis is therefore recommended in such populations when PPD skin testing data are unavailable.