Management of Latent Tuberculosis Infection

Authors: Madhukar Pai, MD, PhD—Author and Series Editor; Camila Rodrigues, MD—co-author
Number of pages: 4
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Overview: Most individuals who get exposed to Mycobacterium tuberculosis (MTB) manage to eliminate or contain the infection using host T-cell immune defenses. However, some MTB bacilli may remain viable (latent) and “reactivate” later to cause active TB disease. This state is called Latent TB Infection (LTBI). Identification and treatment (i.e. preventive therapy or prophylaxis) of LTBI can substantially reduce the risk of development of active disease (by as much as 60%). However, because 40% of Indians are latently infected, LTBI screening must be restricted to specific high risk populations in India, where the benefits of LTBI treatment outweigh any risks. These include people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor (TNF-alpha) treatment, patients with end stage renal failure on dialysis, patients preparing for organ or haematologic transplantation, and patients with silicosis. While either tuberculin skin test (Mantoux) or interferon-gamma release assays (e.g., TB Gold) can be used for LTBI screening, it is important to make sure that these tests are not used for active TB diagnosis. For persons with symptoms or abnormal chest x-rays, physicians should order smears, cultures, and molecular tests (e.g., Xpert MTB/RIF). If LTBI is diagnosed, then physicians must rule-out TB disease with chest x-rays before starting one of the recommended drug regimens. It is important to ensure adherence, and provide adequate counseling to ensure that patients do not stop therapy prematurely.

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Management of Latent Tuberculosis Infection

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  1. Content was good and well summarized but just limited to Indian experience. In fact WHO had recommended the usage of INH prophylaxis but then few countries have moved forward. We just started pushing the implementation in Swaziland since 2012 and now under the HIV & AIDS program this is a well monitored activity in preventing PLWH from getting active TB. Baylor in Swaziland went as far as conducting a survey on children and INH prophylaxis effectiveness with excellent outcome. I designed for the program an IPT card to engage patient in monitoring the IPT ( Isonizid Prophylaxis Therapy) and just remaining approval to pass as a national tool. Few other matters to mention are the pill burden in people on ARVs; ADR (adverse drug reactions) as well like mental condition when on Effavirenz or increased liver toxicity when on Niverapine. Again all these need systematic studies to really measure the benefits which of course remain greater then complications.

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