Reports on HIV/AIDS: 1990

MAY 18, 1990, MMWR, Vol. 39, RR-8: [inclusive page numbers]
* Residents of facilities for long-term care (e.g., correctional institutions, nursing
homes, and mental institutions).
In addition to the groups listed above, public health officials should be alert for
other high-risk populations in their communities. For example, through a review of
cases reported in the community over several years, health officials may use
geographic or sociodemographic factors to identify groups that should be targeted
for intervention. Screening and preventive therapy programs should be initiated and
promoted within these populations based on an analysis of cases and infection in the
community. To the extent possible, members of high-risk groups and their healthcare providers should be involved in the design, implementation, and evaluation of
these programs. Staff of facilities in which an individual with disease would pose a
risk to large numbers of susceptible persons (e.g., correctional institutions, nursing
homes, mental institutions, other health-care facilities, schools, and child-care facilities) may also be considered for preventive therapy if their tuberculin reaction is
~t10 mm induration.
Preventive Therapy
The usual preventive therapy regimen is isoniazid (10 mg/kg daily for children, up
to a maximum adult dose of 300 mg daily). The recommended duration of isoniazid
preventive treatment varies from 6 to 12 months of continuous therapy (9). Twelve
months of therapy is recommended for persons with HIV infection and persons with
stable abnormal chest radiographs consistent with past tuberculosis. The other
groups should receive a minimum of 6 continuous months of therapy.
To ensure that persons in high-risk groups comply with therapy, health-care
personnel should, if necessary, directly observe the therapy. Isoniazid can be given
twice weekly in a dose of 15 mg/kg (up to 900 mg) when therapy must be directly
observed and resources are inadequate for daily therapy. Recommendations of the
ACET are summarized in Table 1.
TABLE 1. Criteria for determining need for preventive therapy for persons with
positive tuberculin reactions, by category and age group
Age group (yrs)
Category <35 ý-35
With risk factor* Treat at all ages if reaction to 5TU purified protein derivative (PPD):>10 mm (or >5 mm and patient is recent contact, HIV-infected, or
has radiographic evidence of old TB)
No risk factor Treat if PPD <10 mm Do not treat
High-incidence groupt
No risk factor Treat if PPD <15 mm' Do not treat
Low-incidence group
*Risk factors include HIV infection, recent contact with infectious person, recent skin-test
conversion, abnormal chest radiograph, intravenous drug abuse, and certain medical risk
factors (see text).
tHigh-incidence groups include foreign-born persons, medically underserved low-income populations, and residents of long-term-care facilities.
"Lower or higher cut points may be used for identifying positive reactions, depending upon the
relative prevalence of Myobacterium tuberculosis infection and nonspecific cross-reactivity in
the population.

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