(HealthDay News) — For HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone does not confer a benefit with respect to survival, according to a study published in the Oct 12 issue of the New England Journal of Medicine.

Joseph Donovan, PhD, from the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, and colleagues conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults with tuberculous meningitis in Vietnam and Indonesia. In addition to 12 months of antituberculosis chemotherapy, participants were randomly assigned to receive a 6- to 8-week tapering course of dexamethasone or placebo (263 and 257, respectively).

The researchers found that during 12 months of follow-up, death occurred in 44.1% and 49.0% of participants in the dexamethasone and placebo groups, respectively (hazard ratio, 0.85; 95% CI, 0.66-1.10; P = 0.22). In prespecified analyses, no subgroup was found that clearly benefited from dexamethasone. The 2 trial groups had a similar incidence of secondary end points, including cases of immune reconstitution inflammatory syndrome during the first 6 months. The 2 groups had similar numbers of participants with at least 1 serious adverse event (73.0% and 75.5%, respectively).

“We did not find a benefit of adjunctive dexamethasone in HIV-positive adults with tuberculous meningitis with respect to survival or any secondary end point over a period of 12 months,” the authors write.

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HealthDay News — A strategy of 8 weeks of bedaquiline-linezolid is noninferior to a standard regimen for tuberculosis, according to a study published online February 20 in the New England Journal of Medicine to coincide with the annual Conference on Retroviruses and Opportunistic Infections, held from February 19 to 22 in Seattle.

Nicholas I. Paton, MD, from the Yong Loo Lin School of Medicine at the National University of Singapore, and colleagues conducted an adaptive, open-label, noninferiority trial involving participants with rifampicin-susceptible pulmonary tuberculosis. A total of 674 participants were randomly assigned to undergo standard treatment (rifampicin and isoniazid for 24 weeks with pyrazinamide and ethambutol for the first 8 weeks) or a strategy involving initial treatment with an 8-week regimen, extended treatment for persistent clinical disease, monitoring after treatment, and retreatment for relapse; 4 participants withdrew consent or were lost to follow-up. Four strategy groups were included with different initial regimens; noninferiority was assessed in 2 groups with complete enrollment, with initial regimens of high-dose rifampicin-linezolid and bedaquiline–linezolid.

The researchers found that a primary outcome event (composite of death, ongoing treatment, or active disease at week 96) occurred in 3.9, 11.4, and 5.8%, respectively, of those in the standard treatment group, the strategy group with an initial rifampin-linezolid regimen (adjusted difference, 7.4 percentage points; noninferiority not met), and the strategy group with an initial bedaquiline-linezolid regimen (adjusted difference, 0.8 percentage points; noninferiority met). The 3 groups reported similar incidences of grade 3 or 4 adverse events and serious adverse events.

“This treatment strategy provides a framework for the development of new, short, potent drug regimens and biomarkers for treatment monitoring to maximize cost-effectiveness and outcome benefit,” the authors write.

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Yunfei Li, ScD, from the Harvard TH Chan School of Public Health in Boston, and colleagues quantified trends in racial/ethnic disparities in TB incidence among US-born persons in a time series analysis of national TB registry data for 2011 to 2021.

The researchers found that compared with non-Hispanic White persons, the incidence rate ratios were as high as 14.2 among American Indian or Alaska Native females in an analysis of TB incidence rates for each racial/ethnic population. Females, younger persons, and those with TB attributed to recent transmission had greater relative disparities. Males had greater absolute disparities. In 2011 to 2021, excess TB cases represented 69 and 62% of total cases for females and males, respectively. The investigators found no evidence to suggest a reduction in incidence rate ratios over time; small, statistically nonsignificant increases were seen in most relative disparity measures.

“Reducing barriers to TB prevention activities and ensuring that all persons have access to affordable and effective TB services are essential for accelerating progress toward population-level TB elimination,” the authors write. “Public health action to address disparities requires the collection of evidence to determine the causes of these disparities and the efficiency of interventions to close them.”

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HealthDay News — The US Preventive Services Task Force (USPSTF) recommends screening people at increased risk for latent tuberculosis infection (LTBI). This recommendation forms a final recommendation statement published in the May 2 issue of the Journal of the American Medical Association.

Daniel E. Jonas, MD, MPH, from RTI International, University of North Carolina at Chapel Hill Evidence-Based Practice Center in Research Triangle Park, and colleagues reviewed the evidence on benefits and harms of screening for and treatment of LTBI in adults. Data were included from 113 publications (112 studies with 69,009 patients). The researchers found that none of the studies directly assessed the benefits and harms of screening. Pooled estimates for sensitivity of the tuberculin skin test were 0.80, 0.81, and 0.60 at the 5-, 10-, and 15mm induration thresholds, respectively, while the sensitivity of interferon-gamma release assays varied from 0.81 to 0.90. The pooled estimates of specificity varied from 0.95 to 0.99 for screening tests. For isoniazid vs placebo, a good-quality randomized clinical trial revealed a relative risk for progression to active tuberculosis at five years of 0.35 and an increase in hepatotoxicity. Multiple regimens were efficacious versus placebo or no treatment based on a previously published meta-analysis.

Based on these findings, the USPSTF concludes there is moderate net benefit for preventing active tuberculosis disease by screening symptomatic persons at increased risk for infection for LTBI. Screening is recommended in populations at increased risk (B recommendation).

“Screening for latent tuberculosis infection in people at increased risk is an effective way to identify the infection so that it can be treated before it progresses to active TB,” task force member Gbenga Ogedegbe, MD, MPH, said in a statement.

Evidence Report

Final Recommendation Statement

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