Regimens for treatment of latent tuberculosis infection in nonpregnant adults with HIV infection*

Regimen	Dosing
Rifamycin-based regimens^¶
Isoniazid^Δ and rifapentine (administered with directly observed therapy weekly for 3 months; 3HP)	Isoniazid (orally once weekly for 3 months; direct observation is preferred): 15 mg/kg, rounded up to the nearest 50 or 100 mg; 900 mg maximum Rifapentine (orally once weekly for 3 months; direct observation is preferred): 10 to 14 kg: 300 mg 14.1 to 25.0 kg: 450 mg 25.1 to 32.0 kg: 600 mg 32.1 to 49.9 kg: 750 mg ≥50 kg: 900 mg maximum
Rifampin (self-administered daily for 4 months; 4R)	Rifampin 10 mg/kg (600 mg maximum) orally daily for 4 months
Isoniazid monotherapy regimens
Isoniazid^Δ	Isoniazid 5 mg/kg (300 mg maximum) orally daily^◊

The efficacy and toxicity of these regimens differ, and some are appropriate only for certain patient populations. For a discussion of the clinical approach to selecting a regimen for the treatment of latent tuberculosis, refer to the UpToDate topic on treatment of LTBI in adults with HIV infection. Dosing assumes normal renal and hepatic function. For nonobese individuals, dosing for isoniazid and rifampin is based on actual body weight; optimal dosing for obese individuals has not been established.

LTBI: latent tuberculosis infection; TB: tuberculosis.

* The regimens summarized in the table are for treatment of LTBI due to Mycobacterium tuberculosis presumed to be susceptible to isoniazid and rifamycins. We do not favor use of isoniazid with rifampin for 3 months (3HR) for treatment of LTBI in patients with HIV infection; this regimen confers no benefit over isoniazid monotherapy in terms of efficacy or toxicity, but it does confer risk of drug interactions associated with rifampin.

¶ Rifamycin-containing regimens have the potential for clinically important drug-drug interactions, particularly with antiretroviral agents. Refer to the UpToDate topic on treatment of LTBI for further discussion.

Δ Peripheral neuropathy can occur among patients on LTBI regimens containing isoniazid due to interference with metabolism of pyridoxine and can be prevented with pyridoxine supplementation. For all patients with HIV infection on an LTBI regimen containing isoniazid, we coadminister pyridoxine (25 to 50 mg daily). We also administer pyridoxine to infants of breastfeeding mothers receiving INH.

◊ The duration of isoniazid therapy depends on TB incidence rate. For settings with TB incidence <500 per 100,000 population, we favor a 9-month duration given its established efficacy. A 6-month duration provides some protection; in the setting of difficulty with adherence, providers may prefer to concentrate efforts in ensuring 6 months of therapy. This approach is favored by the World Health Organization (WHO). However, regimens shorter than 9 months should not be used for patients with fibrotic lesions on chest radiograph. For settings with TB incidence ≥500 per 100,000 population, we are in agreement with the WHO guidelines which recommend a duration of at least 36 months. Refer to UpToDate topic on treatment of LTBI for further discussion.

Adapted from: Sterling T, Njie G, Zenner D, et al. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations From the National Tuberculosis Controllers Association and CDC, 2020. MMWR 2020; 69:1.

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Regimens for treatment of latent tuberculosis infection in nonpregnant adults with HIV infection*