CDC and TB

Posted on Dec 13, 2011 in News | 1 comment

New CDC Guidelines for Treating Latent Tuberculosis

The Centers for Disease Control and Prevention (CDC) has just published a new and less onerous regimen to treat latent tuberculosis (TB) infection.[1] The new recommendations provide guidance about how to administer a new 12-dose regimen of TB preventive therapy that will significantly simplify the course of treatment from about nine months to 12 weeks. Many of those with latent TB at high risk of developing TB don’t begin the previously recommended nine-month course of standard treatment; among those who do, many don’t complete it. These new guidelines are expected to improve the numbers of people treated as well as the percentage of those who complete treatment.

Latent TB infection occurs in people who harbor the TB bacteria but have not developed the active disease. The goal of treating latent TB is to head off the development of active TB, at which point symptoms appear and people are able to communicate the disease to others. In the United States, the number of people with active TB disease is at an all-time low; however, approximately 4% of the U.S. population (11 million people) are infected with latent TB, which continues to disproportionately affect foreign-born people and people of color. People with weakened immune systems are at higher risk of progression to active TB disease. As primary care providers, you play a key role in the diagnosis and treatment of TB because of your access to these high-risk populations.

The new recommendations follow recently published results from the New England Journal of Medicine.[2] A once-weekly regimen of the anti-TB drugs rifapentine and isoniazid taken over a period of three months was as effective in preventing TB disease as the standard self-administered nine-month daily regimen of isoniazid alone and was completed by more patients. The new regimen shortens the required doses from 270 daily doses to 12 once-weekly doses.

Highlights of the Recommendations

• The new regimen consists of 12 once-weekly doses of rifapentine and isoniazid. Doses should be supervised by a healthcare provider to ensure completion and to allow for safety monitoring. Clinicians should rule out active TB among all patients before beginning the two-drug regimen.
• The regimen is recommended for otherwise healthy people at least 12 years old and who are at high risk for developing active TB. This regimen may also be considered among populations unlikely to complete nine months of daily therapy (eg, in correctional settings, clinics for recent immigrants, homeless shelters).
• The regimen is not recommended for those younger than 12, women who are pregnant or planning to become pregnant, and HIV-infected persons taking antiretrovirals. Patients whose TB infection is presumed to be the result of exposure to a person with TB disease that is resistant to one of the two drugs should not receive this regimen.
• Monitoring for adverse events is critical. Patients should undergo a clinical assessment at least monthly.

CDC officials note that these recommendations are only for the United States. Countries with a high incidence of TB, especially those with high HIV prevalence and where the risk of TB re-infection is greater, will likely require additional studies before considering whether to recommend this regimen. 

Jill Shuman, MS, ELS
Published December 13, 2011

References

1. Centers for Disease Control and Prevention. Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep. 2011;60(48):1650-1653.
2. Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365(23):2155-2165.