Treatment of latent tb infection

The risk of developing clinical tuberculosis is greatest in patients with latent TB who are also infected with HIV or are receiving immunosuppressive therapy. It is also high in close contacts of patients with recent pulmonary tuberculosis, in those with radiographic evidence of prior TB, during the first 2 years after development of a positive tuberculin test, and in recent immigrants. The risk of serious disease, including miliary tuberculosis and tuberculous meningitis, is highest in infants, the elderly, and in patients with HIV infection or other causes of severe immunosuppression.

Recent studies also indicate high risk for development of clinical TB, including life-threatening and miliary disease, in persons with latent TB who are treated with the TNF-alpha inhibitors infliximab (Remicaid), etanercept (Enbrel), and adalimumab  (Humira). Before beginning therapy with Original publication date - December 2004Drugs for Tuberculosis  these drugs, tuberculin skin testing and, if positive, initiation of treatment for latent TB infection, is recommended.