What is your approach to a positive PPD or IGRA in a patient with well-controlled HIV without significant TB risk factors?
I would treat this patient for LTBI (after ruling out active disease); if the patient was hesitant to be treated, a second test could be done if it would increase their likelihood of adhering to the regimen; but I would urge treatment in any case as the stakes are high if untreated LTBI is present.
...I treat all HIV patients with positive screening tests. I consider HIV itself, regardless of CD4 count, to be the highest risk for reactivation disease. I believe there is data showing this risk to be higher even than organ transplant or cancer treatment patients.
The problem, of course, is navigati...
In an HIV patient without significant risk factors (CD4 nadir >300, no comorbidities), I would offer and encourage treatment for latent Tb but probably not push too hard. For patients who who were willing, I would offer 4 months of rifampin. This would often necessitate changing their ART to doluteg...
The question here is treating a disease (Latent tuberculosis) vs treating a test result.
- While a positive TB quantiferon or IGRA helps, the final diagnosis of LTBI also depends on the additional evidence of epidemiological risk and/or radiological findings.
- Not all positive TB quantiferon results ...
As with most of medicine, it’s risk vs benefit. If the LTBI regimen is well-tolerated with few/no drug interactions would provide INH/Rifapentin weekly x 12, Rifampin x 4 months, INH/rifampin x 3 months, whatever, depending on patient preference. If poorly tolerated, inform the patient and just note...