Tuberculosis chemoprophylaxis

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) incidence in the US is increasing after years of decline.
• This rise is primarily driven by cases within high-risk populations, including individuals with human immunodeficiency virus (HIV), the elderly, foreign-born individuals, and the homeless.
• Tuberculosis carries a significant mortality rate of 10% in the US, even with appropriate treatment.

Purpose of the Study:

• To highlight the resurgence of tuberculosis in the United States.
• To emphasize the importance of screening high-risk populations for tuberculosis infection.
• To discuss the role of preventive treatment in controlling tuberculosis disease progression.

Main Methods:

• Review of current tuberculosis incidence trends and associated risk factors.
• Evaluation of the tuberculin skin test for diagnosing latent tuberculosis infection.
• Assessment of isoniazid preventive therapy for its efficacy and safety.

Main Results:

• Revised diagnostic criteria for the tuberculin skin test aim to improve its predictive value.
• Screening high-risk populations is crucial for identifying individuals who would benefit most from preventive measures.
• Isoniazid therapy (6-12 months) is a safe and highly effective method to prevent latent tuberculosis infection from progressing to active disease.

Conclusions:

• The rising incidence of tuberculosis necessitates targeted screening and preventive strategies, especially in vulnerable populations.
• Isoniazid preventive therapy is a well-tolerated and effective intervention with a very low risk of severe hepatotoxicity ( <0.01% with monitoring).
• Early detection and treatment of latent tuberculosis infection are key to controlling the epidemic and reducing mortality.