# Presentation: 712513

## Treatment of Latent TB Infection (LTBI)

**This is an archived document.**

## Candidates for Treatment of LTBI

- Positive skin test result ****5 mm
- HIV-positive persons
- Recent contacts of a TB case
- Persons with fibrotic changes on chest radiograph
- 	consistent with old TB
- Patients with organ transplants and other
- 	immunosuppressed patients

## Candidates for Treatment of LTBI (cont.)

- Positive skin test result ****10 mm
- Recent arrivals from high-prevalence countries
- Injection drug users
- Residents and employees of high-risk congregate settings
- Mycobacteriology laboratory personnel
- Persons with clinical conditions that make them high-risk
- Children < 4 years of age, or children and adolescents
- 	exposed to adults in high-risk categories

## Candidates for Treatment of LTBI (cont.)

- Positive skin test result ****15 mm
- Persons with no known risk factors for TB may be
- 	considered
- Targeted skin testing programs should only be
- 	conducted among high-risk groups

## Treatment of LTBI with Isoniazid (INH)

- 9-month regimen considered optimal
- Children should receive 9 months of therapy
- Can be given twice-weekly if directly observed

## Treatment of LTBI with a Rifamycin 

- and Pyrazinamide (PZA)

- HIV-Positive Persons
- A rifamycin and PZA daily for 2 months
- May be given twice weekly
- Administration of rifampin (RIF) contraindicated with some
- protease inhibitors (PIs) and nonnucleoside reverse
- transcriptase inhibitors (NNRTIs)
- HIV-Negative Persons
- Clinical trials have not been conducted
- Daily RIF and PZA for 2 months
- May be given twice weekly

## Contacts of INH-Resistant TB

- Treatment with a rifamycin and PZA
- If unable to tolerate PZA, 4-month regimen of daily RIF
- HIV-positive persons: 2 month regimen with a rifamycin and
- PZA
- Contacts of Multidrug-Resistant TB
- Use 2 drugs to which the infecting organism has
- demonstrated susceptibility
- Treat for 6 months or observe without treatment
-  (HIV-negative)
- Treat HIV-positive persons for 12 months
- Follow for 2 years regardless of treatment

## Fibrotic Lesions

- Acceptable regimens include
- 9 months of INH
- 2 months RIF plus PZA
- 4 months of RIF (with or without INH)

- Pregnancy and Breast-feeding
- INH daily or twice weekly
- Pyridoxine supplementation
- Breast-feeding not contraindicated

## Monitoring Patients

- Before treatment for LTBI is started, clinicians should
- Rule out possibility of TB disease
- Determine history of treatment for LTBI or disease
- Determine contraindications to treatment
- Obtain information about current and previous
- 	drug therapy
- Recommend HIV testing if risk factors are present

## Monitoring Patients (cont.)

- Establish rapport with patient and emphasize
- Benefits of treatment
- Importance of adherence to treatment regimen
- Possible adverse side effects of regimen
- Establishment of optimal follow-up plan

## Monitoring Patients (cont.)

- Baseline laboratory testing
- Not routinely indicated
- Baseline hepatic measurements for
-  Patients whose initial evaluation suggests a liver disorder
-  Patients with HIV infection
-  Pregnant women and those in immediate postpartum period
-  Patients with history of chronic liver disorder

## Monitoring Patients (cont.)

- At least monthly, evaluate for
- Adherence to prescribed regimen
- Signs and symptoms of active TB disease
- Signs and symptoms of hepatitis (if receiving
-        isoniazid alone, and at 2, 4, and 8 weeks if
-        receiving RIF and PZA)