From latent to patent: rethinking prediction of tuberculosis disease in infected individuals

Authored by: Cobelens F, Kik S, Esmail H, Cirillo DM, Lienhardt C, Matteelli A.
In: Lancet Resp Med 2016.

Tuberculosis remains a major global health problem. It is estimated that more than 2 billion people around the world are latently infected with Mycobacterium tuberculosis, with a lifetime risk of progression to tuberculosis disease of 5–15%.1 The WHO End Tuberculosis strategy, which aims to end tuberculosis as a major health problem by 2035, calls for reducing this huge reservoir for transmission by scaling up preventive therapy of individuals with latent tuberculosis infection. Preventive therapy with daily isoniazid offers 60–90% protection and combination therapies (daily isoniazid-rifampicin, weekly isoniazid-rifapentine) are effective alternatives.

Ankeiler: In this viewpoint paper Frank Cobelens and co-authors propose a new paradigm for understanding testing for latent tuberculosis infection (LTBI). It distinguishes testing for persistent TB infection from testing for very early clinical („incipient”) TB and argues that only tests that belong to the latter category will be sufficiently predictive for clinical tuberculosis developing within a 2-year timeframe to be used for large-scale test-and-treat of LTBI. This notion has implications for the design, evaluation and application of new LTBI tests.