[Expert consensus on tuberculosis preventive treatment for individuals at high risk of developing active diseases from latent tuberculosis infection in comprehensive medical facilities].

Promoting tuberculosis preventive treatment (TPT) for individuals with latent tuberculosis infection (LTBI) who are at high risk of developing active tuberculosis (TB) is an important tool for accelerating the decline in TB incidence and achieving the global goals of the End TB strategy. As a country with a high burden of TB, China has implemented patient-centred strategies in the past, but TPT has not been systematically implemented. In the comprehensive medical facilities, there are many types of TPT target populations and their health situation is complex, which poses more challenges for TPT implementation. To improve the work of TPT in comprehensive medical institutions, experts organized by the Chinese Medical Association Respiratory Branch and the National Respiratory Medicine Center made the following evidence-based recommendations on the identification of TPT targets and the selection of TPT timing and regimen. Based on comprehensive clinical evaluation, patients in comprehensive medical facilities who are recommended to undergo LTBI testing and TPT include: HIV infections/AIDS patients (1B), patients treated with TNF-α antagonists (1C), patients receiving long-term hemodialysis/peritoneal dialysis (1D), patients planning to receive organ transplantation or bone marrow transplantation (1C), patients with silicosis (1D), patients using glucocorticoids or other immunosuppressants for a long-time (1D), infertile women receiving assisted reproduction (2D). For TPT target populations in comprehensive medical facilities, an appropriate diagnostic technology should be selected to test for MTB infection. After exclusion of active TB, TPT should be suggested to people with LTBI after comprehensive clinical evaluation (1D). In HIV infections/AIDS patients with LTBI, TPT should be started as soon as possible regardless of whether antiretroviral treatment has been initiated (1B). 6H, 9H, 3HR and 3HP regimens could be used in HIV-HIV infections/AIDS patients with LTBI (1A). For HIV infections/AIDS patients at high risk of MTB exposure, it is recommended to use isoniazid alone for 36 months or longer for TPT (1B). In patients treated with TNF-α antagonists and with LTBI, 3HR and 3HP regimen is recommended for TPT (1B). In patients treated with TNF-α antagonists and with LTBI, 6H regimen can be used as an alternative for those with contraindications to combined medication or drug-induced liver injury (1B). If necessary, the TPT cycle can be extended to 6 months, depending on the course of TNF-α antagonist use (1C). In patients treated with TNF-α antagonists and with LTBI, the timing of TPT should be based on clinical assessment. TNF-α antagonist treatment can be started 4 weeks after TPT in non-urgent disease states (1C), and can be given concomitantly in emergency states (1C). For patients who receive long-term hemodialysis or peritoneal dialysis and with LTBI, 6H regimen is recommended as the preferred regimen for TPT (2B). For patients who receive long-term hemodialysis or peritoneal dialysis and with LTBI, 3HR or 3HP regimen can be used as alternatives based on clinical evaluation according to patient compliance (2D). The timing of TPT varies according to different dialysis methods: in patients on peritoneal dialysis, TPT is administered at regular doses and is not affected by the timing of administration; in patients on hemodialysis, it is recommended to administer after the completion of hemodialysis (1D). For recipients who are planning to receive organ transplantation or bone marrow transplantation and with LTBI, 9H regimen is recommended for TPT (1B). Prior to organ transplantation or bone marrow transplantation, it is recommended to screen the donor for LTBI. If the donor is LTBI positive, the recipient should be suggested for TPT (1D). For recipients who are planning to receive organ or bone marrow transplantation, TPT does not have to be completed before transplantation. TPT interrupted because of transplantation should be resumed as soon as possible when the condition is stable (1D). In patients who have undergone liver transplantation, if TPT is required, it is recommended to be carried out when post-transplant liver function is stable (1D). In silicosis patients with LTBI, 6H regimen is recommended for TPT (1D). For patients on long-term oral glucocorticoids (prednisone equivalent dose≥15 mg/d for more than 4 weeks) or other immunosuppressants and with LTBI, based on comprehensive clinical evaluation, 3HP regimen is recommended for TPT. In patients with contraindications to combined medication, 6H or 9H can be used as an alternative (1B). In patients taking long-term oral glucocorticoids (prednisone equivalent dose≥15 mg/d for more than 4 weeks) or use other immunosuppressants and with LTBI, the timing of initiation of TPT should be determined by the status of the primary disease. If the condition permits, it is recommended to give priority to TPT for one month before initiating glucocorticoid or other immunosuppressive therapy (2D). It is recommended that infertile women undergoing assisted reproduction should undergo LTBI testing. For those with latent genital TB, TPT is recommended using regimen for active TB treatment. For those with LTBI and reproductive system samples that are negative for TB nucleic acid testing, 6H regimen is recommended for TPT (2D).