The U.S. Centers for Disease Control and Prevention (CDC) has issued updated recommendations regarding the use of 3HP (once-weekly isoniazid-rifapentine for 12 weeks) for the treatment of latent tuberculosis (TB) infection.
In 2011, the CDC recommended the use of 3HP by directly observed therapy (DOT) for the treatment of latent TB infection in adult patients with limitations for use in children <12 years old and persons with HIV infection. In 2017, a Work Group was assembled to conduct a systematic review of 3HP regimen studies published between January 2006 to June 2017, specifically looking at outcomes in children, individuals with HIV/AIDS, and those who self-administered treatment.
An analysis of 19 articles found that 3HP was as safe and effective as other recommended latent TB infection regimens and that it achieved substantially higher treatment completion rates. As a result, the CDC is expanding its recommendation for the 3HP regimen to include patients aged 2 to 11 years old; patients with comorbid HIV infection (including AIDS) who are taking antiretrovirals with acceptable drug-drug interactions with rifapentine; and as either DOT or self-administered therapy (SAT) in those ≥2 years old.
Liver enzymes and other blood tests should be performed for certain patients prior to starting 3HP therapy. Patients taking concomitant rifamycin compounds (eg, rifapentine, rifampin) should be monitored if prescribed concomitant methadone or warfarin. As rifapentine may also antagonize hormonal contraceptives, women who use hormonal birth control should be counseled to add or switch to a barrier method.
Healthcare providers should determine the mode of administration (DOT vs SAT) based on local practice, individual patient characteristics and preferences, and other factors such as risk for progression to severe forms of TB. Use of concomitant antiretrovirals during latent TB infection treatment should be monitored by clinicians experienced in managing both conditions.
Experts concluded that more studies are needed to understand the regimen's pharmacokinetics, safety, and tolerance in patients <2 years old; adherence and safety of 3HP-SAT in patients aged <18 years old, and safety of 3HP during pregnancy.
For more information visit CDC.gov.