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USPSTF Maintains Recommendation of Latent TB Infection Screening for At-Risk People

NEW YORK — The US Preventive Services Task Force on Tuesday reiterated its previous recommendation that people at increased risk for latent tuberculosis infection (LTBI) should be screened for the disease.

LTBI is an asymptomatic and noninfectious form of tuberculosis that can later progress to active disease. While its exact prevalence in the US is unclear, the USPSTF estimates that it affects around 13 million people, with incidence varying by geography and living accommodations.

In 2016, the agency recommended LTBI screening for populations at increased risk, but recently commissioned a systematic evidence review to update this guidance, focusing on the benefits and harms of screening and treatment in asymptomatic adults seen in primary care, as well as the accuracy of screening tests.

In the Journal of the American Medical Association, the USPSTF stated that that current screening tests for LTBI are moderately sensitive and highly specific. These tests include the decades-old tuberculin skin test and newer blood-based interferon-gamma release assays from Qiagen and PerkinElmer, all of which detect immune responses to the Mycobacterium tuberculosis bacterium that causes TB.

While there is no clinical data available on the health outcomes of LTBI-screened populations versus unscreened populations, a 1982 study found that LTBI treatment was associated with a decreased risk of developing active tuberculosis, the USPSTF wrote.

The USPSTF noted that additional research into LTBI screening is needed, specifically around the accuracy of risk assessment tools that help identify who is at increased risk for LTBI and who should receive screening; which populations should receive repeat screening and how often; and which screening strategies are more effective in specific patient populations.

Still, based on currently available information, the USPSTF concluded with "moderate certainty that there is a moderate net benefit in preventing active tuberculosis disease by screening for LTBI in persons at increased risk for tuberculosis infection."

This finding echoes those of the US Centers for Disease Control and Prevention, as well as the American Thoracic Society and the Infectious Diseases Society of America, which all recommend screening for LTBI to identify people who may benefit from treatment before progression to active tuberculosis infection.