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LTBI, poz or neg, 2RZ or INH, TST or IGRA
Mar 2, 2008

As the acronyms in my title suggest, these are questions about tuberculosis.

I'm a 35-year-old male from a high-prevalence TB country (but have been in the States for the last three years and another seven years in the 90s). Mantoux/PPD reactive, induration >10 mm. Chest x-rays always clear (2005, 2008, mid-90s, as a kid). BCG vaccination as a child.

(1) Is this LTBI or not?

(2) Should I get a QuantiFERON TB Gold (obnoxious name) test? What is the specificity and sensitivity of the QuantiFERON (IGRA) test?

(3) My doctor is urging chemoprophylaxis. I'm reluctant to undertake nine months of INH; would prefer two months of rifampin and pyrazinamide.

(4) There appears to be greater hepatoxicity with the 2RZ regimen with HIV-negative people, much less so with HIV-positive folk. This appears counter-intuitive, to say the least; any explanations why?

(5) My numbers are CD4s 600-900, percentage mid-30s, barely detectable VL. (I'm the guy who writes "Keeping you posted [sixth labs]".) Is TB treatment warranted in my case or not?

(6) I'm a moderate to occasionally heavy drinker (that meaning, a once-a-week "binge"). All LFTs always normal. Hep A and Hep B vaccinated, no Hep C. But does this "history" of alcohol use mean that the two-month regimen is strongly contraindicated, even if I do not drink before and during the treatment?

This is a perplexing decision. I'd appreciate your input. Thanks.

Response from Dr. Holodniy

1. Most likely. 2. Don't think it's necessary. It can be false negative in HIV infected patients. 3. The 2 month regimen is an acceptable option. 4. I don't have a good explanation for that. 5. Yes. 6. Either regimen should not be a problem, provided you don't drink during the treatment course.



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