Prevalence and treatment outcomes of LTBI among older patients with COPD in Taiwan

Who

• Population: Older adults (>60 years) with COPD diagnosed per GOLD 2023 criteria (FEV₁/FVC <70%).

• Sample: 920 eligible; 819 (89.0%) underwent LTBI screening.

  • IGRA-positive: 193 (23.6%); IGRA-indeterminate: 9 (1.1%).

  • TPT recipients: 150 IGRA-positive participants (77.7% of positives).

• Demographics: Mean age ~72 years; majority male (~85%).

• Key comorbidities: Hypertension (53.8%), hyperlipidemia (33.7%), asthma (33.1%).

• Risk behaviors: 24.3% current smokers; high cumulative smoking exposure among IGRA-positive individuals.

What

• Focus: Determining the prevalence and predictors of latent tuberculosis infection (LTBI) among older COPD patients and evaluating completion and safety of various LTBI treatment regimens.

• Main findings:

  • LTBI prevalence: 23.6% via IGRA.

  • Predictors of IGRA positivity: Greater smoking pack-years, longer COPD duration, current smoking, history of cerebrovascular accident, inhaled corticosteroid (ICS) use, and cumulative prednisolone dose >210 mg in 2 years.

  • Treatment completion: Overall TPT completion 82.0%; highest in 3HP (91.2%), lowest in 9H (50.0%).

  • Safety: Adverse drug reactions (ADRs)—especially systemic drug reactions (SDRs) and hepatotoxicity—were the leading cause of discontinuation. Ten patients experienced AECOPD during treatment; four deaths occurred (three respiratory, one cardiac and unrelated to LTBI therapy).

• Implications: Older COPD patients have substantial LTBI prevalence and multiple clinical predictors; shorter rifapentine- or rifampin-based regimens showed higher completion rates but notable SDR risk.

When

• Study period: January 2021 – February 2024.

Where

• Setting: Prospective multicenter study in Taiwan at:

  • Taichung Veterans General Hospital

  • Kaohsiung Medical University Hospital

  • National Taiwan University Hospital and affiliated centers.

Why

• Rationale: COPD patients are at high risk for reactivation TB, yet LTBI prevalence, predictors, and regimen-specific outcomes in this population are insufficiently defined. Understanding these factors is essential for optimizing LTBI strategies and supporting TB elimination efforts.

How

• Design: Prospective multicenter cohort.

• Screening: IGRA using QuantiFERON-Gold or Gold-Plus.

• Treatment: WHO-recommended LTBI regimens (1HP, 3HP, 3HR, 4R, 9H) chosen via shared decision-making and administered under directly observed preventive therapy (DOPT/eDOPT).

• Monitoring:

  • Baseline labs (CBC, liver/renal panel, hepatitis, HIV).

  • Daily or dose-based ADR monitoring; monthly or biweekly biochemical testing depending on regimen.

  • ADR causality assessed using Naranjo score; severity guided management.

• Analysis: Baseline comparisons and multivariate logistic regression to identify predictors of IGRA positivity; regimen-wise assessment of completion and ADRs.

Source: Huang, H.L., Cheng, M.H., Lee, M.R., Chien, J.Y., Lu, P.L., Sheu, C.C., Wang, J.Y., Chong, I.W., Yang, J.M. and Huang, W.C., 2025. Prevalence and treatment outcomes of latent tuberculosis infection among older patients with chronic obstructive pulmonary disease in an area with intermediate tuberculosis burden. Emerging Microbes & Infections, 14(1), p.2497302.