Latent tuberculosis infection: updated and consolidated guidelines for programmatic management

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Latent tuberculosis infection: updated and consolidated guidelines for programmatic management

Recommendations

Chest radiography may be offered to people living with HIV and on ART and preventive treatment given to those with no abnormal radiographic findings.

The absence of any symptoms of TB and the absence of abnormal chest radiographic findings may be used to rule out active TB disease among HIV-negative household contacts aged ≥ 5 years and other at-risk groups before preventive treatment.

Infants aged < 12 months living with HIV who are in contact with a case of TB and are investigated for TB should receive 6 months of isoniazid preventive treatment (IPT) if the investigation shows no TB disease.

All children living with HIV who have successfully completed treatment for TB disease may receive isoniazid for an additional 6 months

In countries with a low TB incidence, adults, adolescents and children who are household contacts of people with bacteriologically confirmed pulmonary TB should be systematically tested and treated for latent tuberculosis infection (LTBI).

Patients initiating anti-TNF treatment, patients receiving dialysis, patients preparing for an organ or haematological transplant and patients with silicosis should be systematically tested and treated for latent tuberculosis infection (LTBI)

In countries with a low TB incidence, systematic testing for and treatment of latent tuberculosis infection (LTBI) may be considered for prisoners, health workers, immigrants from countries with a high TB burden, homeless people and people who use illicit drugs

Systematic testing for latent tuberculosis infection (LTBI) is not recommended in people with diabetes, people with harmful alcohol use, tobacco smokers, and underweight people unless they are already included in the above recommendations

Adults and adolescents living with HIV who are screened for TB according to a clinical algorithm and who report any of the symptoms of current cough, fever, weight loss or night sweats may have active TB and should be evaluated for TB and other diseases that cause such symptoms

Either a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) can be used to test for latent tuberculosis infection (LTBI)

People living with HIV who have a positive test for latent tuberculosis infection (LTBI) benefit more from preventive treatment than those who have a negative LTBI test; LTBI testing can be used, where feasible, to identify such individuals.

Latent tuberculosis infection (LTBI) testing by TST (Tuberculin Skin Test) or IGRA (Interferon-Gamma Release Assays) is not a requirement for initiating preventive treatment in people living with HIV or child household contacts aged < 5 years

Isoniazid monotherapy for 6 months is recommended for treatment of LTBI in both adults and children in countries with high and low TB incidence

Rifampicin plus isoniazid daily for 3 months should be offered as an alternative to 6 months of isoniazid monotherapy as preventive treatment for children and adolescents aged < 15 years in countries with a high TB incidence

Rifapentine and isoniazid weekly for 3 months may be offered as an alternative to 6 months of isoniazid monotherapy as preventive treatment for both adults and children in countries with a high TB incidence

In selected high-risk household contacts of patients with multidrug-resistant tuberculosis, preventive treatment may be considered based on individualised risk assessment and a sound clinical justification