Which populations should specifically be tested for latent TB before initiating INH?

Individuals with HIV should be specifically tested for latent tuberculosis (TB) before initiating isoniazid (INH) because they are at a significantly higher risk of developing active TB disease. HIV compromises the immune system, which reduces the body’s ability to control the latent TB infection. If latent TB is not identified and treated in someone with HIV, there’s a much greater chance that the infection will advance to active TB, which can be severe and life-threatening.

Testing for latent TB is a critical step to ensure that any underlying infections are managed appropriately before starting treatments like INH. This is particularly important given that the use of INH is aimed at preventing the progression to active TB. In individuals with compromised immunity, such as those with HIV, the risk-benefit balance of initiating preventative therapy must be carefully evaluated.

Other populations, while they may also benefit from latent TB testing under certain circumstances, are not as high-risk as individuals with HIV. Healthy individuals typically have a reduced risk of developing TB. Children under five may be at risk for TB but are not universally required to be tested in the same manner as those with HIV. Similarly, travelers to developing countries might have an increased risk of exposure, but testing is not as routinely mandated for them as