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U.S. Department of Health and Human Services


Guide for Primary Health Care Providers: Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection

Changes Found in the 2000 Guidelines and Subsequent Updates

Testing for LTBI

  • Tuberculin skin testing discouraged for those at low risk for developing TB disease
  • Testing recommended for high-risk individuals, regardless of age
  • Lower cut-off point established for organ transplant recipients and other immunosuppressed persons (on daily prednisone for one or more months); 5 mm induration considered positive
  • TST conversion considered an increase in induration of at least 10 mm within a 2-year period, regardless of age
  • The QuantiFERON®-TB test and QuantiFERON®-TB Gold test (QFT) are blood tests that measures a person’s immune reactivity to M. tuberculosis
  • Prolonged use of immunosuppressive agents such as TNF-α antagonists increases risk of progression from LTBI to TB disease

Treatment of LTBI

  • INH for 9 months preferred over 6-month regimen for HIV-negative individuals
  • INH for 9 months for HIV-infected persons or those with old TB (fibrotic lesions on chest radiograph)
  • RIF for 4 months for HIV-uninfected and HIV-infected individuals
  • RIF and PZA for 2 months should generally not be offered due to risk of severe adverse events

Clinical and laboratory monitoring

  • Baseline and laboratory monitoring needed for HIV-infected persons, pregnant or postpartum women, and persons who have chronic liver disease or who regularly use alcohol
  • Follow-up only indicated if baseline tests are abnormal
  • Tests include serum AST, ALT, and bilirubin
  • Emphasis on clinical monitoring for signs of possible adverse drug reactions

Key: INH – Isoniazid RIF – Rifampin PZA – Pyrazinamide


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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