TB treatment regimes in people living with HIV

Intermittent dosing regimens to treat pulmonary tuberculosis (TB) are commonly implemented, particularly in the developing world, in an attempt to improve adherence, reduce costs and reduce side effects. Gopolan et al (JAMA Intern Med 2018;178:485-93) aim to test the efficacy of daily vs part daily (daily for the intensive phase followed by thrice weekly continuation phase) vs intermittent (thrice weekly) TB treatment in HIV positive individuals who were TB treatment naive. This question was pertinent in India as the Revised National TB Programme continued to recommend intermittent treatment. From September 2009 to January 2016 331 patients were allocated equally to the three arms. The trial was stopped early by the data monitoring and safety committee. In the modified intent-to-treat analysis, favourable responses at the end of TB treatment occurred in 89 of 98 patients (91%), 77 of 96 patients (80%), and 75 of 98 patients (77%) in the daily, part-daily, and intermittent regimens, respectively. Daily treatment was associated with an improved response (absolute increase in response rate 14%, 95% CI 4% to 25%, P=0.009) whereas part-daily was not (P=0.53). This trial shows that daily treatment for patients with pulmonary …