From the Guidelines
Test of cure is not routinely recommended after completion of latent tuberculosis infection (LTBI) treatment. The World Health Organization guidelines for low tuberculosis burden countries, as published in the European Respiratory Journal in 2015 1, emphasize the importance of prioritizing high-risk groups for latent TB testing and treatment, but do not support the routine use of testing to confirm cure after treatment. This approach is based on the understanding that currently available tests, such as the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), cannot distinguish between active infection, latent infection, or cleared infection.
Some key points to consider in the management of LTBI include:
- The decision to test and treat for LTBI should be based on the principle that the benefit outweighs the risk to the individual, considering local epidemiology and resource availability 1.
- High-risk groups, such as people living with HIV, adult and child contacts of pulmonary TB cases, and immigrants from high to low TB burden countries, should be prioritized for latent TB testing and treatment 1.
- The choice of treatment regimen should consider factors such as resource requirements, feasibility, and patient acceptability, with shorter duration regimens generally preferred over longer ones 1.
- Clinical monitoring for symptoms of active TB disease is the appropriate follow-up strategy after completion of LTBI treatment, rather than routine post-treatment testing 1.
Overall, the focus should be on educating patients about symptoms of active TB and instructing them to seek medical attention if these develop, rather than relying on routine post-treatment testing. This approach is supported by the available evidence and guidelines, and is aimed at optimizing outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Test of Cure After Latent TB Treatment
- The provided studies do not directly address the question of whether a test of cure is recommended after latent TB treatment 2, 3, 4, 5, 6.
- However, the studies discuss various treatment regimens for latent TB infection, including their efficacy, safety, and treatment completion rates.
- For example, a 1-month regimen of rifapentine plus isoniazid was found to be noninferior to 9 months of isoniazid alone for preventing tuberculosis in HIV-infected patients 4.
- A 3-month isoniazid-rifapentine regimen was determined to be equal to other latent TB infection regimens in effectiveness and has higher treatment completion rates 5.
- The studies suggest that the choice of treatment regimen may depend on various factors, including the patient's HIV status, CD4+ count, and antiretroviral therapy 3, 4, 6.
- While the studies provide information on the treatment of latent TB infection, they do not explicitly address the question of whether a test of cure is recommended after treatment.