Preventive treatment for latent tuberculosis from Indian perspective

Abstract

The persistent morbidity and mortality associated with tuberculosis (TB), despite our continued efforts, has been long recognized, and the rise in the incidence of drug-resistant TB adds to the preexisting concern. The bulk of the TB burden is confined to low-income countries, and rigorous efforts are made to detect, notify, and systematically treat TB. Efforts have been infused with renewed vigor and determination by the World Health Organization (WHO) to eliminate tuberculosis in the near future. Different health agencies worldwide are harvesting all possible strategies apart from consolidating ongoing practices, including prevention of the development of active disease by treating latent TB infection (LTBI). The guidelines for the same were already provided by the WHO and were then adapted in the Indian guidelines for the treatment of LTBI in 2021. While the long-term impact of TBI treatment is awaited, in this article, we aim to discuss the implications in the Indian context.

Figure 1

Schematic diagram depicting the events in the pathogenesis of primary TB infection. M.tb: Mycobacterium tuberculosis, CR3: complement 3 receptor, MHC: major histocompatibility complex, IFN: interferon

Figure 2

Factors to be considered to assess the feasibility of mass TB preventive treatment in India