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Do you treat ltbi

Answer

Latent tuberculosis infection (LTBI) is treated. The primary goal of treating LTBI is to prevent the progression to active tuberculosis (TB), particularly in individuals at high risk for reactivation. High-risk groups include recent contacts of active TB cases, individuals with HIV infection, those with immunosuppressive conditions or treatments, and individuals with fibrotic changes on chest radiographs consistent with old TB.

Treatment regimens

Treatment in specific populations

  • For patients with HIV infection, the WHO 2024 guidelines recommend offering daily isoniazid preventive treatment for at least 36 months in adult and adolescent patients living with HIV with an unknown or a positive latent tuberculosis test unlikely to have active tuberculosis in settings of high tuberculosis transmission, regardless of antiretroviral therapy, the degree of immunosuppression, history of previous tuberculosis treatment, and pregnancy status
  • For contacts of patients with multidrug-resistant tuberculosis (MDR-TB), the American Thoracic Society/Centers for Disease Control and Prevention/European Respiratory Society/Infectious Diseases Society of America (ATS/CDC/ERS/IDSA) 2019 guidelines suggest initiating treatment for latent tuberculosis infection

Monitoring and adherence

In conclusion, treatment of latent tuberculosis infection is a critical component of tuberculosis control, aimed at preventing the progression to active disease. Multiple treatment regimens are available, and the choice of regimen should be individualized based on patient characteristics, potential drug interactions, and risk of progression to active disease. Monitoring for adverse effects and ensuring treatment adherence are key aspects of LTBI management.

References

1

Pulmonary tuberculosis

Medical management

Guidelines

Management of latent tuberculosis

Pathway
CDC/.../NTCA 2020