Patients with epidemiological risk factors for TB (history of exposure to TB, previous TB, emigrants from high TB prevalence areas, residents in high incidence areas, co morbidities associated with increased risk of TB, professional activities with increased risk of exposure to TB, travel to endemic areas), or chest X-ray sequelae of untreated previous TB, or positive TST and/or IGRA, should start LTBI treatment, after exclusion of active TB (Evidence level C and D). Whenever find more there is evidence of exposure to TB (regardless the results of the screening and after exclusion of active TB) or LTBI (positive TST and/or IGRA or changes in chest radiograph suggestive of

previous untreated TB), after exclusion of active TB, preventive treatment should be offered before initiating biological therapy, as these patients have a high risk of progression to disease.19, 21, 54, 55, 56 and 57 Due to the risk of serious forms of disease, treatment must be offered to candidates for biological therapy regardless of age and presumed date of infection. Isoniazid for 9 months (Evidence level C and D). Several therapeutic strategies have been proposed. Isoniazid is classically recommended ABT 888 as this drug in immunocompromised patients has proven to be effective

(data derived from multiple studies in HIV patients).58, 59 and 60 Isoniazid for a period of 9 months is the most commonly used regimen and has an estimated efficacy of around 90%. This regimen is recommended by the American Thoracic Society (ATS)61 and Canadian Tuberculosis Standards,62

while the 6 months regimen, in which effectiveness varies between 65 and 69%, is proposed by the National Institute for Health and Clinical Excellence (NICE).63 TBNET recommends treatment with isoniazid for 9–12 months or isoniazid and rifampicin for 3 months (3HR).19 However, the later is associated with a lower efficacy (around 60%). Some studies indicate that 4 months of rifampicin (4R) are at least as effective as 3HR and this regime has the advantage of being better accepted by patients, having fewer adverse effects when compared Farnesyltransferase with regimens based on isoniazid and is associated with a lower cost to the health system.64, 65, 66, 67 and 68 These are very relevant advantages but effectiveness remains uncertain, as this regimen has not yet been tested extensively in randomized trials. In the light of current knowledge, treatment with isoniazid for 9 months is the most consensual option.19, 59 and 60 One month is defined as the minimum LTBI treatment duration before starting biological drugs.19 This recommendation is based on expert opinion. Patient education, clinical monitoring, baseline and monthly laboratory testing of liver enzymes (Evidence level C and D).