Gao Lei’s Team Scales New Heights in the Intervention of Latent Tuberculosis Infection

2018-10-31

On October 25, Gao Lei and his colleagues of Institute of Pathogen Biology published an article titled “Short-course Regimens of Rifapentine plus Isoniazid to Treat Latent Tuberculosis Infection in Older Chinese: a Randomized Controlled Study” in European Respiratory Journal. In the randomized controlled study, the intervention regimen for latent tuberculosis infection recommended by WHO was verified and evaluated in Chinese population, with an aim to work out the short-course regimen more appropriate in China.

 

The prevention and control of global tuberculosis (TB) epidemic is in the face of serious challenge. Accordingly, subsequent to the Ministerial Meeting of Health Ministers to end the global TB epidemic in Moscow last year, the 73th United Nations General Assembly convened a high-level meeting this year on TB prevention and treatment to call on governments around the world from the political level to participate in the drive for the global strategy of ending TB epidemic in 2035. Currently 23% of the world population is plagued by latent tuberculosis infection (LTBI), which is one of the major sources of TB. Intervention of LTBI is an important means to achieve the strategic goal of END TB. The World Health Organization (WHO) has recently proposed two initiatives on LTBI interventions in eligible countries. However, China has not yet formed a systematic guide to the management of LTBI. During the “12th Five-Year Plan” period, the Institute of Pathogen Biology pioneered the world’s largest epidemiological investigation and cohort study project on mycobacterium tuberculosis (MTB) infection and obtained the LTBI rate of 13.5%~19.8% in rural resident population in different TB epidemic research sites in China for the first time, to provide an important data reference for the feasibility of latent infection intervention in China (Lancet Infect Dis.2015; Eur Respir J.2016). The study also suggested that elderly people, especially those with a history of TB, are at high risk of MTB infection and morbidity, and are the key target population requiring preventive intervention against LTBI (Lancet Infect Dis. 2017). Elderly TB patients account for over 70% of new TB patients in China. If preventive intervention can be successfully carried out among the elderly patients with latent infection, the incidence rate in the population can be significantly reduced.

 

On this basis, to explore short-range intervention protocols with good safety and protective effects suitable for elderly people, the investigator Gao Lei took the lead in implementing the randomized controlled intervention research on elderly people with latent infection from 2014 to 2017. In this study, detection of latent infection was carried out for a total of 20,000 elderly people, and 3,900 patients with positive infection that met the inclusion criteria were recruited. They were randomly divided into three groups: blank control group, WHO recommended protocol group, and innovative ultra-short-range test group. After completion of the intervention, a two-year follow-up was conducted to obtain the incidence of active tuberculosis in each group. The study found that compared to the untreated group, the hazard ratios of incident TB in the two intervention groups were 0.63 (95% CI, 0.27-1.43) and 0.41 (95% CI, 0.15-1.09), respectively. This is the first time that the WHO recommended intervention protocol has been evaluated among the population in China, and the results suggest that it should be careful when this protocol (using domestic drugs) is applied amongst the elderly population in China. Besides, the 6-week intervention protocol showed a good protective effect, providing important data support for the exploration of a super-short-range intervention protocol suitable for the situation of China and population characteristics. This intervention protocol also serves as the world’s most officially published short-range intervention protocol, significantly improving the compliance of intervention objects.

 

The investigator Gao Lei from Institute of Pathogen Biology is the first author of this paper, and investigator Jin Qi is the corresponding author. This research project was financially supported by the Innovation Fund for Medical Sciences of Chinese Academy of Medical Sciences (CAMS) (2016-I2M-1-013) and National Science and Technology Major Project for Infectious Diseases in China (No. 2014ZX10003001-001).

 

Paper link: http://erj.ersjournals.com/content/early/2018/09/27/13993003.01470-2018

 

 

(Institute of Pathogen Biology)