The U.S. Preventive Services Task Force (USPSTF) recommends screening people at increased risk for latent tuberculosis infection (LTBI). This recommendation forms a final recommendation statement published in the May 2 issue of the Journal of the American Medical Association.
Daniel E. Jonas, M.D., M.P.H., from RTI International—University of North Carolina at Chapel Hill Evidence-Based Practice Center in Research Triangle Park, and colleagues reviewed the evidence on benefits and harms of screening for and treatment of LTBI in adults. Data were included from 113 publications (112 studies with 69,009 patients). The researchers found that none of the studies directly assessed the benefits and harms of screening.
Pooled estimates for sensitivity of the tuberculin skin test were 0.80, 0.81, and 0.60 at the 5-, 10-, and 15-mm induration thresholds, respectively, while the sensitivity of interferon-gamma release assays varied from 0.81 to 0.90. The pooled estimates of specificity varied from 0.95 to 0.99 for screening tests.
For isoniazid versus placebo, a good-quality randomized clinical trial revealed a relative risk for progression to active tuberculosis at five years of 0.35 and an increase in hepatotoxicity. Multiple regimens were efficacious versus placebo or no treatment based on a previously published meta-analysis.
Based on these findings, the USPSTF concludes there is moderate net benefit for preventing active tuberculosis disease by screening symptomatic persons at increased risk for infection for LTBI. Screening is recommended in populations at increased risk (B recommendation).
“Screening for latent tuberculosis infection in people at increased risk is an effective way to identify the infection so that it can be treated before it progresses to active TB,” task force member Gbenga Ogedegbe, M.D., M.P.H., said in a statement.
Leila C. Kahwati et al, Primary Care Screening and Treatment for Latent Tuberculosis Infection in Adults, JAMA (2016). DOI: 10.1001/jama.2016.10357
Final Recommendation Statement: Screening for Latent Tuberculosis Infection in Adults, JAMA (2023). DOI: 10.1001/jama.2023.4899
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