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Background: The incidence of TB among Inuit is the highest in Canada. A significantly shorter latent TB infection (LTBI) treatment with rifapentine and isoniazid once weekly for 12 weeks (3HP) is now available in limited settings in Canada. Methods: A prospective open-label 2-year observational postmarketing study was conducted introducing 3HP for the first time in Canada in Iqaluit followed by a program rollout in Qikiqtarjuaq, Nunavut. Results: A total of 247 people were offered 3HP, 102 in the Iqaluit postmarketing study and 145 in the Qikiqtarjuaq program roll out. Although statistical significance was not reached, more people who started treatment completed treatment in the 3HP group (Iqaluit, 60/73 (82.2%) and Qikiqtarjuaq, 89/115 (77.4%)) than in the historical control 9INHgroup (306/420 = 72.9%) (p = 0.2). Most of the adverse events in 3HP treated patients were associated with mild discomfort but no disruption of normal daily activity. Not drinking alcohol was associated with increased 3HP completion (OR 13.33, 95% CI, 2.27–78.20) as was not taking concomitant medications (OR 7.19, 95% CI, 1.47–35.30). Conclusions: The present study supports the feasibility and safety profile of 3HP for the treatment of LTBI in Nunavut. [ABSTRACT FROM AUTHOR]

Despite recent success in reducing its incidence, tuberculosis remains a considerable challenge in Canada, particularly among foreign-born and Indigenous populations. A key component of the strategy for controlling the disease is the treatment of latent tuberculosis infection (LTBI). The standard treatment consists of isoniazid (INH) daily for nine months. In recent years, shorter regimens have been developed in the hope of increasing rates of treatment acceptance and completion. Of these, the shortest and most recently developed is a combination of INH and rifapentine taken once weekly for 12 doses (3HP), typically using directly observed therapy. This regimen has been approved by the Food and Drug Administration in the United States but is not yet authorized for use in Canada. Based on a rapidly expanding number of observational studies and randomized controlled trials, 12 weeks of 3HP appears to have similar efficacy to nine months of INH, a favourable adverse event profile and potentially improved rates of treatment completion. Although rates of treatment acceptance, the role of self-administered therapy and the regimen's cost-effectiveness within the Canadian context remain uncertain, 3HP is a promising alternative to existing treatments for LTBI. [ABSTRACT FROM AUTHOR]

Although Canada has a low incidence of tuberculosis (TB), certain populations, including the foreign-born and Canadian-born Indigenous peoples, continue to be disproportionately represented among reported cases. The overall incidence rates of active TB in Canada have not significantly changed in the past decade and work still needs to be done to reach TB elimination goals set by the World Health Organization (WHO). In trying to achieve TB elimination in Canada, primary care clinicians, with the support of public health professionals and TB experts, can help by focusing on 1) targeted screening and treatment of latent TB infection (LTBI) and 2) timely diagnosis and referral of active TB disease. The following article focuses on some key primary care considerations to keep in mind in day-to-day patient care. To help conduct targeted screening and treatment for LTBI, several key populations, including immigrants from high TB burden countries, Indigenous peoples and several other at-risk groups, are outlined. Reactivation of LTBI plays a significant role in TB burden and is likely an area of major potential impact in achieving TB elimination. Advancement in LTBI treatment, including short course therapy, is also described. In addition, to help make a timely diagnosis of active TB, several key risk factors, including several co-morbidities which increase the risk of developing TB disease, can be considered. Being front-line in patient care, keeping in mind some of these key pearls may aid primary care providers to have potential impact on eliminating TB in Canada. [ABSTRACT FROM AUTHOR]

Background Cancer is a health concern in Inuit populations. Unique cultural, dietary, and genetic factors and geographic isolation influence cancer epidemiology in this group. Inuit-specific data about oncology treatments and survival outcomes in Canadian Inuit referred to urban treatment centres are lacking. Methods A retrospective chart review of Inuit patients referred to The Ottawa Hospital Cancer Centre (TOHCC) from the Baffin region of Nunavut between 2000 and 2010 was conducted. Nunavut cancer registry data were used to establish the percentage of cancer cases referred and their survival outcomes. Results Of 307 cancer patients registered among Baffin-region Inuit, 216 [70% (63 men, 153 women)] were referred to tohcc for chemotherapy (CT) and radiation therapy (RT). Mean age in the referred group was 59.3 years (range: 25-89 years), and current smokers constituted half the group (52%). The cancers most commonly leading to referral in men were lung (55%), colorectal (19%), and nasopharyngeal (11%) cancers; in women, they were lung (46%), colorectal (24%), breast (10%), nasopharyngeal (6%), and cervical (5%) cancers. Of the 216 referred patients, 82 (38%) had already undergone surgery, and 18 (8%) received chemoradiation or RT only, all given with curative intent. Among the surgical patients referred, 33 (40%) and 23 (28%) went on to receive adjuvant CT and adjuvant RT respectively. Among 116 patients referred for palliative care, 64 (55%) received CT, 76 (66%) received RT, 43 (37%) received both CT and RT, and 19 (16%) received neither treatment. Median all-stage overall survival was 10 months for patients with lung cancer [95% confidence interval: 6.1 to 13.9 months] and 37 months for patients with colorectal cancer [95% confidence interval: 14.8 to 59.2 months]. Conclusions High uptake of palliative and adjuvant CT and RT was observed in the Inuit patients referred to TOHCC. Lung cancer was the most common cancer in referred Inuit men and women. The survival rates for Inuit lung cancer patients referred to TOHCC were comparable to those in the rest of Canada. Further research is required to understand reasons for non-referral of Canadian Inuit to TOHCC. [ABSTRACT FROM AUTHOR]

Background. High HIV burden countries have experienced a high burden of pleural TB in HIV-infected patients. Objective. To review the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients. Methods. A literature search from 1950 to June 2011 in MEDLINE was conducted. Results. Two-hundred and ninety-nine studies were identified, of which 30 met the inclusion criteria. The immunopathogenesis as denoted by cells and cytokine profiles is distinctly different between HIV and HIV-uninfected pleural TB disease. Adenosine deaminase and interferon gamma are good markers of pleural TB disease even in HIV-infected patients. HIV-uninfected TB suspects with pleural effusions commonly have a low yield of TB organisms however the evidence suggests that in dually infected patients smear and cultures have a higher yield. The Gene Xpert MTB/RIF assay has significant potential to improve the diagnosis of pleural TB in HIV-positive patients. Conclusions. Pleural TB in HIV-infected patients has a different immunopathogenesis than HIV-uninfected pleural TB and these findings in part support the differences noted in this systematic review. Research should focus on developing an interferon gamma-based point of care diagnostic test and expansion of the role of Gene Xpert in the diagnosis of pleural TB. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses the 2013 data from the Canadian Tuberculosis (TB) Reporting System which suggests the incidence rate of active TB disease in Canada has not changed.

The article offers information on a study that used a case-finding method to identify adults in the community with respiratory symptoms but without a diagnosed lung disease. Topics include the study's methodology, which involved enrollment in a randomized trial to determine if early diagnosis and treatment reduce health care utilization and improve outcomes, and the results, which showed lower health care utilization.