Treatment of latent tuberculosis infection in HIV-uninfected adults
- C Robert Horsburgh, Jr, MD, MUS
C Robert Horsburgh, Jr, MD, MUS
- Professor of Epidemiology, Biostatistics and Medicine
- Boston University School of Public Health
Treatment of individuals with active tuberculosis (TB) is the first priority for TB control; an important second priority is identification and treatment of individuals with latent TB infection (LTBI). The World Health Organization (WHO) recommends that LTBI treatment be included as part of the TB control program for high income or upper middle income countries with an estimated TB incidence rate of less than 100 per 100,000 population per year .
In most individuals, Mycobacterium tuberculosis infection is contained initially by host defenses, and the infection remains in a prolonged, suppressed state termed "latency" . However, latent infection has the potential to develop into active infection (termed "active disease") at any time. Identification and treatment of LTBI greatly reduces the likelihood of reactivation and so has potential to protect the health of the individuals as well as the public by reducing the number of potential sources of infection [3,4].
Following LTBI treatment, the durability of protection against reactivation is variable and depends upon regional prevalence of TB and risk for reexposure. LTBI treatment may confer lifelong protection against disease; among Alaskan Eskimos, for example, the protective effect of isoniazid prophylaxis has been shown to persist for more than 19 years .
Treatment of LTBI should be initiated only once active TB has been excluded . The approach to treatment of LTBI in HIV-uninfected patients will be reviewed here. LTBI in children and diagnostic testing for LTBI in HIV-uninfected patients are discussed in detail separately, as is management of LTBI for patients with HIV or receiving tumor necrosis factor-alpha inhibitors. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults" and "Treatment of latent tuberculosis infection in HIV-infected adults" and "Tumor necrosis factor-alpha inhibitors and mycobacterial infections" and "Latent tuberculosis infection in children".)
WHOM TO TREAT
The goal of testing for latent tuberculosis infection (LTBI) is to identify individuals who are at increased risk for the development of tuberculosis and therefore would benefit from treatment of LTBI. Only those who would benefit from treatment should be tested, so a decision to test presupposes a decision to treat if the test is positive. This is discussed further separately. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults".)
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- WHOM TO TREAT
- TREATMENT REGIMENS
- Isoniazid and rifapentine
- Isoniazid and rifampin
- SELECTING A REGIMEN
- General approach
- Interrupted LTBI therapy
- Treatment of drug-resistant LTBI
- Continuation of LTBI treatment after presumptive treatment for TB disease
- SUBSEQUENT MANAGEMENT
- INTERNATIONAL GUIDELINES
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS