From the Guidelines
Yes, it is possible to have latent tuberculosis (TB) and never exhibit symptoms, as approximately one third of the world’s population is estimated to be infected with Mycobacterium tuberculosis without clinical evidence of active tuberculosis (TB) 1. The condition is characterized by the presence of immune responses to Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Key points to consider include:
- The vast majority of infected persons have no signs or symptoms of TB disease and are not infectious, but they are at risk for developing active TB disease and becoming infectious 1.
- The lifetime risk of reactivation TB for a person with documented LTBI is estimated to be 5–15%, with the majority developing TB disease within the first 5 years after initial infection 1.
- The likelihood of progression of LTBI to active TB depends on bacterial, host, and environmental factors 1.
- Preventive treatment can avert the reactivation of TB, with currently available regimens for the treatment of LTBI having an efficacy ranging from 60% to 90%, the protection of which can last for up to 19 years 1.
- The potential benefit of treatment needs to be carefully balanced against the risk of drug-related adverse events, particularly in population groups with a high risk of progression to active disease, where the anticipated benefits are usually greater than the potential harms 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Latent Tuberculosis Infection
- Latent tuberculosis infection (LTBI) is an asymptomatic, noncommunicable infection caused by Mycobacterium tuberculosis 2.
- Approximately 10 million people worldwide were infected with tuberculosis (TB) in 2019, and up to 13 million people were living with LTBI in the United States 2.
- Without treatment, LTBI will progress to active TB disease in approximately 5% to 10% of affected people 2.
Asymptomatic TB Infection
- Most infected immunocompetent individuals are asymptomatic, and only 5-10% of these will eventually develop active TB during their lifetime 3.
- The spectrum of asymptomatic Mycobacterium tuberculosis (Mtb) infections includes the dynamic state of latent TB infection (LTBI) and the preclinical state of incipient and subclinical TB 3.
- Incipient and subclinical TB may be as prevalent as symptomatically active TB and potentially contributes to global Mtb transmission in various settings 3.
Treatment and Management
- The U.S. Preventive Services Task Force recommends testing individuals at increased risk of LTBI with an interferon-gamma release assay or tuberculin skin testing 2.
- Preferred treatment regimens for LTBI include isoniazid in combination with rifapentine or rifampin, or rifampin alone for a duration of three and four months, respectively 2.
- Short-course regimens, such as 3-month isoniazid-rifapentine, have been shown to be effective and safe for treating LTBI, with higher treatment completion rates compared to longer-duration regimens 4, 5, 6.