The CDC has expanded its recommendation of a short-course combination regimen of once-weekly isoniazid and rifapentine for the treatment of latent tuberculosis infection to include children aged 2 to 11 years and patients with HIV/AIDS taking antiretroviral medications.
Children with latent tuberculosis infection (LTBI) should be treated to prevent them from developing active TB disease, according to health officials. However, the CDC’s recommendations from 2011 limited the use of the shortest regimen currently available — once-weekly isoniazid and rifapentine for 12 weeks (3HP), Andrey S. Borisov, MD, medical epidemiologist at the CDC’s Division of Tuberculosis Elimination, told Infectious Diseases in Children.
“At that time, not enough data were available to recommend 3HP for children under 12 years old, persons living with HIV/AIDS and taking antiretroviral therapy, or as a self-administered therapy,” he said.
A CDC Work Group, which included epidemiologists, health scientists, physicians from the CDC’s Tuberculosis Elimination Program and a CDC library specialist, conducted a meta-analysis of 19 articles, which included 15 unique studies. The target population included persons aged at least 12 years, children aged 2 to 11 years or people living with HIV.
The researchers found that 3HP was as safe and effective as other LTBI treatment regimens in the target populations.
Based on the findings, the CDC continues its recommendation of 3HP for treating LTBI in adults. However, new recommendations by the CDC include the use of 3HP for patients aged 2 to 17 years and patients with HIV infection, including AIDS, and are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine. The recommendations also include using 3HP by self-administered therapy or directly observed therapy in patients aged at least 2 years.
The researchers also provided guidance to health care providers on the use of 3HP treatment for LTBI, including:
- evaluating all patients for active TB before and during treatment;
- informing patients or parents of possible adverse effects;
- ·ordering baseline hepatic chemistry blood tests for patients with certain conditions, including HIV, liver disorder, postpartum period of 3 months or less after delivery, regular alcohol use, injection drug use, or use of medications with known possible interactions; and
- conducting blood tests for patients whose baseline testing is abnormal and for patients who are risk for liver disease.
“Pediatricians should work with parents or legal guardians to determine the best treatment plan and to provide support and resources to help patents complete treatment successfully,” Borisov said. “CDC encourages clinicians and public health professionals to review and implement the updated recommendations, which include guidance on patient education and monitoring.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.