Rifapentine for latent tuberculosis infection treatment in the general population and human immunodeficiency virus-positive patients: summary of evidence

Abstract

Latent tuberculosis infection (LTBI) and human immunodefi ciency virus (HIV)-coinfection are challenges in the control of tuberculosis transmission. We aimed to assess and summarize evidence available in the literature regarding the treatment of LTBI in both the general and HIV-positive population, in order to support decision making by the Brazilian Tuberculosis Control Program for LTBI chemoprophylaxis. We searched MEDLINE, Cochrane Library, Centre for Reviews and Dissemination, Embase, LILACS, SciELO, Trip database, National Guideline Clearinghouse, and the Brazilian Theses Repository to identify systematic reviews, randomized clinical trials, clinical guidelines, evidence-based synopses, reports of health technology assessment agencies, and theses that investigated rifapentine and isoniazid combination compared to isoniazid monotherapy. We assessed the quality of evidence from randomized clinical trials using the Jadad Scale and recommendations from other evidence sources using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The available evidence suggests that there are no differences between rifapentine + isoniazid short-course treatment and the standard 6-month isoniazid therapy in reducing active tuberculosis incidence or death. Adherence was better with directly observed rifapentine therapy compared to self-administered isoniazid. The quality of evidence obtained was moderate, and on the basis of this evidence, rifapentine is recommended by one guideline. Available evidence assessment considering the perspective of higher adherence rates, lower costs, and local peculiarity context might support rifapentine use for LTBI in the general or HIV-positive populations. Since novel trials are ongoing, further studies should include patients on antiretroviral therapy.

Access and adherence to isoniazid preventive therapy and occurrence of active TB in a cohort of people living with HIV: a retrospective cohort study in Sao Paulo, Brazil

“…However, 11.7% of our patients missed the TST measurement appointment, revealing potential pitfalls in the cascade of latent TB diagnosis and treatment. Strategies to further improve access and adherence to PTI have been explored by several authors, including shorter duration regimens, use of digital technologies to improve adherence and retention in care, use of simplified treatment regimens or use of regimens with better tolerance [36][37][38] . In addition, access to PTI could be improved with the implementation of the interferon-γ release assay testing in settings with scarcity of TST or whenever an additional visit to the clinic to assess the TST result is not feasible 39 .…”

Malaria and tuberculosis as diseases of neglected populations: state of the art in chemotherapy and advances in the search for new drugs

“…In comparison to the standard regimen therapy for LTBI and to 3-month isoniazid-rifapentine regimen, the latter exhibits a similar efficacy of isoniazid monotherapy for six or nine months, presenting a low frequency of adverse effects and a higher completion rate. (77,78,79) Pretomanid (PA-824) (Table II) is a bicyclic imidazole able to destroy both replicant and non-replicating bacilli through different mechanisms. According to the authors, the inhibition of mycolic acids leads to cell wall disruption (isoniazid-like), which is the death-inducing effect of PA-824 against replicating/active bacteria, while its anaerobic killing activity is related to its NO releasing potential, causing respiratory poisoning in the microorganism.…”

“…In comparison to the standard regimen therapy for LTBI and to 3-month isoniazid-rifapentine regimen, the latter exhibits a similar efficacy of isoniazid monotherapy for six or nine months, presenting a low frequency of adverse effects and a higher completion rate. 77 , 78 , 79 …”

Short-course isoniazid plus rifapentine therapy for latent tuberculosis in Brazil

“…This regimen has been found to reduce the treatment time from 6 months to 3 months and the number of doses from 180 to 12 (2) . A manuscript entitled Rifapentine for tuberculosis treatment infection latent in the general population and human immunodeficiency virus-positive patients: summary of evidence, which is published in the same issue of the Brazilian Society of Tropical Medicine (3) , provides an important review of the subject and justifies the recommendation of this new regimen for the treatment of LTBI in Brazil.…”