Screening and treatment for LTBI in elderly patients with poorly controlled DM [TB0110]

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Compared to the 9H regimen, the 3-month weekly rifapentine plus isoniazid (3HP) regimen has similar efficacy in TB prevention, a lower risk of hepatotoxicity, a 10% higher completion rate, and greater cost-effectiveness. In this pilot project, funded by the Taiwan CDC, patients with pre-diabetes mellitus (pDM) were enrolled by endocrinologists and treated by pulmonologists as part of a multidisciplinary team in two hospitals. We reported the screening and preventive therapy completion rates for LTBI, with a focus on the 3HP regimen.

This prospective study was conducted between April 2018 and June 2020 at a medical center in Taichung and a regional hospital in Kaohsiung. Through collaboration among public health professionals, endocrinologists, and pulmonologists, programmatic LTBI intervention achieved a 92.7% LTBI screening rate and an 82.5% completion rate among patients receiving TPT. Approximately one-quarter of patients with pDM had LTBI, a prevalence higher than that of TB close contacts (15%) and hemodialysis patients (19.3%) in Taiwan—both of which are recommended by WHO for LTBI treatment.

These findings suggest that patients with pDM should be considered a priority group for LTBI interventions, especially elderly individuals with prolonged DM duration and impaired renal function. Despite a higher incidence of adverse drug reactions (mostly mild, grade 1 and 2) with the 3HP regimen and the extended duration of the 9H regimen, both regimens had an 80% completion rate, underscoring the importance of a collaborative multidisciplinary team and efficient public health programming.

Additionally, metformin appears to provide protection against LTBI. As a first-line therapy for DM, metformin may offer benefits in TB treatment due to its potential to enhance phagolysosome function, modulate the innate immune response to Mycobacterium tuberculosis, and reduce chronic inflammation in the infected lung.

Source: Huang, H.L., Huang, W.C., Lin, K.D., Liu, S.S., Lee, M.R., Cheng, M.H., Chin, C.S., Lu, P.L., Sheu, C.C., Wang, J.Y. and Lee, I.T., 2021. Completion rate and safety of programmatic screening and treatment for latent tuberculosis infection in elderly patients with poorly controlled diabetic mellitus: a prospective multicenter study. Clinical Infectious Diseases, 73(6), pp.e1252-e1260.

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