Oct 26, 2011

Diagnosing latent tuberculosis in high-risk individuals: rising to the challenge in high-burden areas

The Journal of Infectious Diseases
Victoria O KasprowiczAjit Lalvani

Abstract

A key challenge to greater progress in tuberculosis (TB) control is the reservoir of latent TB infection (LTBI), which represents a huge long-lived reservoir of potential TB disease. In parts of Africa, as many as 50% of 15-year-olds and 77%-89% of adults have evidence of LTBI. A second key challenge to TB control is the human immunodeficiency virus (HIV)-associated TB epidemic, and Africa alone accounts for one-quarter of the global burden of HIV-associated TB. HIV co-infection promotes both reactivation TB from LTBI and rapidly progressive primary TB following recent exposure to Mycobacterium tuberculosis. Preventing active TB and tackling latent infection in addition to the Directly Observed Treatment, Short-Course (DOTS) strategy could improve TB control in high-burden settings, especially where there is a high prevalence of HIV co-infection. Current strategies include intensified case finding (ICF), TB infection control, antiretroviral therapy (ART), and isoniazid preventive therapy (IPT). Although ART has been widely rolled out, ICF and IPT have not. A key factor limiting the rollout and effectiveness of IPT and ICF is the limitations of existing tools to both diagnose LTBI and identify those persons most at risk of progr...Continue Reading

  • References122
  • Citations17

References

Mentioned in this Paper

Tuberculosis
Tuberculosis, Meningeal
Coinfection
HIV Infections
Interferon-gamma Release Tests
Latent Tuberculosis
Mycobacterium tuberculosis
Mycobacterium Tuberculosis, Susceptibility TO (Finding)

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