Tuberc Respir Dis.  2014 Jun;76(6):261-268.

Diagnosis and Treatment of Latent Tuberculosis Infection due to Initiation of Anti-TNF Therapy

• Shim TS

Abstract

Patients with immune-mediated inflammatory diseases (IMIDs) are increasingly being treated with anti-tumor necrosis factor (TNF) agents and are at increased risk of developing tuberculosis (TB). Therefore, diagnosis and treatment of latent TB infection (LTBI) is recommended in these patients due to the initiation of anti-TNF therapy. Traditionally, LTBI has been diagnosed on the basis of clinical factors and a tuberculin skin test. Recently, interferon-gamma releasing assays (IGRAs) that can detect TB infection have become available. Considering the high-risk of developing TB in patients on anti-TNF therapy, the use of both a tuberculin skin test and an IGRA should be considered to detect and treat LTBI in patients with IMIDs. The traditional LTBI treatment regimen consisted of isoniazid monotherapy for 9 months. However, shorter regimens such as 4 months of rifampicin or 3 months of isoniazid/rifampicin are increasingly being used to improve treatment completion rates. In this review, the screening methods for diagnosing latent and active TB before anti-TNF therapy in patients with IMIDs will be briefly described, as well as the current LTBI treatment regimens, the recommendations for managing TB that develops during anti-TNF therapy, the necessity of regular monitoring to detect new TB infection, and the re-initiation of anti-TNF therapy in patients who develop TB.

Keyword

Latent Tuberculosis; Tuberculin Test; Interferon-gamma Release Tests; Tumor Necrosis Factor-alpha

MeSH Terms

Diagnosis*
Humans
Interferon-gamma
Interferon-gamma Release Tests
Isoniazid
Latent Tuberculosis*
Mass Screening
Necrosis
Rifampin
Skin Tests
Tuberculin
Tuberculin Test
Tuberculosis
Tumor Necrosis Factor-alpha
Interferon-gamma
Isoniazid
Rifampin
Tuberculin
Tumor Necrosis Factor-alpha

Figure

• 

  Figure 1 Algorithm for the selection of candidates requiring LTBI treatment. TB: tuberculosis; CXR: chest radiography; CT: computed tomography; LTBI: latent tuberculosis infection.

• 

  Figure 2 Diagnosis of LTBI in immunocompromised adults. The appropriate method, either a combination of TST/IGRA (A) or IGRA alone (B), should be chosen based on circumstances of individual patient. The negative LTBI test is not recommended with TST alone, and a positive TST is diagnosed as LTBI. IGRA: interferon-gamma releasing assay. TB: tuberculosis; IGRA: interferon-gamma releasing assay; LTBI: latent tuberculosis infection; TST: tuberculin skin test.

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