Matteelli Alberto, Sulis Giorgia, Capone Susanna, D'Ambrosio Lia, Migliori Giovanni Battista, Getahun Haileyesus
University of Brescia, WHO Collaborating Centre for TB/HIV co-infection and TB Elimination, Department of Infectious and Tropical Diseases, Brescia, Italy.
University of Brescia, WHO Collaborating Centre for TB/HIV co-infection and TB Elimination, Department of Infectious and Tropical Diseases, Brescia, Italy.
Presse Med. 2017 Mar;46(2 Pt 2):e13-e21. doi: 10.1016/j.lpm.2017.01.015. Epub 2017 Mar 6.
Latent tuberculosis infection (LTBI) affects one third to one fourth of the human population and is the reservoir for a significant proportion of emerging active tuberculosis (TB) cases, especially in low incidence countries. The World Health Organization launched in 2015 the END-TB strategy that aims at TB elimination and promotes, for the first time ever, the management of LTBI. The preventive package, basically consisting of testing and treatment for LTBI in groups at high risk of reactivation, is a mainstay of the first pillar of the strategy, alongside prompt diagnosis and early treatment of both drug-susceptible and drug-resistant TB disease. Testing and treatment for LTBI should be pursued with a programmatic perspective. This implies strong political commitment, adequate funding and an effective monitoring and evaluation system. People living with HIV and children under five years of age who are household contact of a contagious TB cases are primarily targeted in all epidemiological setting. In high resource and low incidence setting, additional at risk populations should also be the target for systematic LTBI testing and treatment. Research is urgently needed to develop diagnostic tests with higher predictive value to identify individuals that progress from infection to disease. Similarly, shorter and safer treatment regimens are needed to make the trade-off between potential benefits and harms more favourable for an increasing proportion of infected individuals.
潜伏性结核感染（LTBI）影响着全球三分之一至四分之一的人口，并且是相当一部分新发活动性结核病（TB）病例的感染源，尤其是在结核病低发国家。世界卫生组织于2015年启动了“终止结核病”战略，旨在消除结核病，并首次推动对LTBI的管理。预防性综合措施主要包括对具有高复发风险人群进行LTBI检测和治疗，这是该战略第一支柱的主要内容，同时还包括对药物敏感和耐药结核病的快速诊断和早期治疗。LTBI的检测和治疗应从规划的角度进行。这意味着要有坚定的政治承诺、充足的资金以及有效的监测和评估系统。在所有流行病学环境中，艾滋病毒感染者以及五岁以下且与传染性结核病病例有家庭接触的儿童是主要目标人群。在资源丰富和低发病率地区，其他高危人群也应成为系统性LTBI检测和治疗的对象。迫切需要开展研究，以开发具有更高预测价值的诊断测试，来识别从感染发展为疾病的个体。同样，需要更短、更安全的治疗方案，以便在潜在益处和危害之间进行权衡，使越来越多的感染者获得更有利的结果。
