Preventive chemotherapy. Where has it got us? Where to go next? [State of the art series. Tuberculosis. Edited by I. D. Rusen. Number 2 in the series]
Although only a minority of those with LTBI will develop active disease, the risk varies substantially according to the time since infection and medical risk factors. If persons at low risk for TB are selected for preventive chemotherapy, the individual and public health benefits are low, and a large number will have to be treated to prevent a single active case. It is therefore important to identify and treat patients who are at high risk of disease.
Tools for rapid and reliable identification of persons with LTBI who are most likely to progress to active disease are urgently needed, as this will permit rational use of preventive treatment by restricting treatment to those patients with the most favourable risk/benefit ratio. The major challenges are efficient identification of those at highest risk of developing disease and ensuring treatment completion with a non-toxic regimen. If these can be overcome, preventive treatment holds the promise to substantially assist in the achievement of global control of TB.
Document Type: Invited Paper
Affiliations: Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
Publication date: December 1, 2008
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