Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Abstract

To tackle the tuberculosis (TB) epidemic, in 2014 the World Health Organization launched the End TB Strategy, which includes action to prevent latent TB infection (LTBI) reactivation. Available preventive treatments (PT) are based on either isoniazid (INH) alone or rifampicin (RIF)-containing regimens. This study aims to assess and compare PT completion rates, the occurrence of adverse events, and the time of dropout among those receiving INH-alone or RIF-containing regimens at Villa Marelli Institute, Milan, Italy, covering the period from 1992 to 2018. A total of 19,670 subjects, belonging to various risk groups—mainly young (median age of 29 years), foreign-born (73.3%), and males (58.8%)—with presumed LTBI were prescribed PT (79.3% INH-alone and 20.7% RIF-containing regimens). The treatment completion rate was 79.4% on average, with higher rates among those receiving RIF-containing regimens (85.6%) compared to those that were prescribed INH-alone (77.8%) (p < 0.0001). Notably, some of the high-risk groups for progression of LTBI were more likely to complete PT from RIF-containing regimens. These groups included recent TB contact (89.9%, p < 0.0001), healthcare workers (93.5%, p < 0.0001), and homeless people (76.6%, p < 0.0001). Irrespectively of the chosen PT regimen, most of the dropouts occurred between the start of the treatment and the first follow-up visit (14.3%, 15.2% for those on INH-alone vs. 11.1% for those on RIF-containing regimens). Further shortening of the PT regimen is therefore an aim to ensure adherence, even though it might need further efforts to enhance the patient’s attitude towards starting and carrying out PT.

Prevalence and Risk Factors of Latent Tuberculosis Infection (LTBI) in Patients with Type 2 Diabetes Mellitus (T2DM)

“…The exact mechanism of the development of LTBI is still unclear; however, there is growing evidence suggesting that the risk of reactivation of LTBI into an active TB is greater in some noncommunicable diseases which affect the function of the immune system. Even though the rate of latent TB reactivation is around 10% [ 5 , 6 ], the risk of reactivation is many folds higher in immunosuppressed patients and patients with type 2 diabetes mellitus (T2DM) [ 7 , 8 , 9 ].…”

Photoclick Reaction Programming Glutathione-Responsive System for Granuloma-Tracking and Anti-Tuberculosis

“…[10][11][12][13] Recently, the surgical intervention accompanied by indispensable antitubercular drug therapy is the primary routine treatment. [14][15][16][17] Although rifampicin (RIF) and isoniazid have been widely chosen as clinical anti-tubercular drugs due to their excellent effectiveness and reasonable price, [18][19][20][21][22] their short plasma-life and relatively low concentration in tuberculosis granulomas, and the inescapable side effects of chemotherapeutic drugs have drawn growing attention from interdisciplinary and clinical medicine research circles. [23][24][25] Thus, there is an urgent need to develop an e cient chemotherapy strategy for tuberculosis.…”

Rv0579 Is Involved in the Resistance to the TP053 Antitubercular Prodrug

“…Current recommended LTB treatments include one of the following options: once-weekly isoniazid plus rifapentine for 3 months, daily rifampin for 4 months, daily isoniazid plus rifampin for 3-4 months, and daily isoniazid for 6-9 months (Huaman and Sterling, 2019). Treatments based on rifamycins seem to cause less adverse events and, consequently, to improve the therapy completion (Villa et al, 2019).…”