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Socio-political prescriptions for latent tuberculosis infection are required to prevent reactivation of tuberculosis.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Coussens, Anna K. Mason, Paul H. Oni, Tolu |
| Copyright Year | 2017 |
| Abstract | In their review article, Fox et al. detail how the screening and treatment of latent tuberculosis infection (LTBI), an asymptomatic condition, can be coupled with the treatment of active tuberculosis to reduce the global burden of tuberculosis (TB). They differentially sort risk factors associated with disease progression from LTBI to TB based on exposures and comorbidities, outline rationales for different preventive therapy regimens to prevent drug-susceptible and drug-resistant TB, and reflect upon ethical considerations of the widespread scale-up of LTBI treatment. Their clinical and epidemiological considerations are robust, and they recognize that the treatment of active TB alone will be in sufficient to achieve the steep annual reductions in incidence necessary to reach the End TB Strategy targets. However, they do not acknowledge the undeniable impact that improvements in living and social conditions has on reducing TB incidence. We believe that the politics and ethics of LTBI treatment need to be taken one step further. Given the contextual factors that foster the reactivation of TB in the absence of evident comorbidities, the blanket screening for LTBI using non-specific diagnostic technology with limited predictive value for the risk of TB progression, with the goal of treating LTBI suspects with 3–9 months of multi-drug regimens, outsources social, economic, and political issues and frames them as biomedical problems. Administering populationwide LTBI treatment, it follows, is political. Should global health initiatives buttress the impoverished social conditions that foster TB reactivation in this manner? Fox et al. argue that the risk of drug toxicity and benefits of treatment must be carefully balanced for each individual. Risks and benefits are reconfigured from a public health perspective. Given that only in the instance of high transmission risk and the presence of known TB risk factors can a greater risk of TB development be predicted following a positive LTBI test, blanket TB preventive therapy, which only targets a current infection, is questionable. Is it not overtreatment to administer TB prophylaxis based on the results of an immunological test that only measures prior exposure, gives no indication of current infection status, is poorly predictive of the risk of TB development (those that revert to negative following recent positive conversion are at greater risk of TB than those who remain positive), and is less sensitive in those at greatest risk of disease (i.e., those who are HIV-infected)? In the face of recurrent exposure in high-burden settings, is treatment of LTBI the most economic choice for long-term disease prevention? |
| Starting Page | 115 |
| Ending Page | 116 |
| Page Count | 2 |
| File Format | PDF HTM / HTML |
| DOI | 10.1016/j.ijid.2017.01.033 |
| PubMed reference number | 28161463 |
| Journal | Medline |
| Volume Number | 58 |
| Alternate Webpage(s) | https://research-management.mq.edu.au/ws/portalfiles/portal/85423126/17777267.pdf |
| Alternate Webpage(s) | https://doi.org/10.1016/j.ijid.2017.01.033 |
| Journal | International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
