6-year follow-up of 522 HIV-positive individuals screened for<i>Mycobacterium tuberculosis</i>infection in Denmark

Søborg, Christian; Rühwald, Morten; Andersen, Peter Henrik; Ravn, Pernille

doi:10.1183/09031936.00170913

Cited by 8 publications

(6 citation statements)

References 10 publications

(27 reference statements)

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“…[36] We have included this in our model, though this may underestimate the effectiveness of testing, as recent studies find a zero or very low risk of active TB in people with negative IGRA results, or those with LTBI who take preventive therapy. [22,23,29] Of the total population assessed, only 8% were new HIV diagnosesyet these are a group not on ART who are at greatest risk of TB reactivation. The small numbers in our study make it hard to draw conclusions or develop guidance regarding testing for LTBI.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the tests above, along with participant characteristics and uptake in the study, were used to undertake an economic analysis based on thirty predefined testing strategies. The assumptions used within the different strategies are listed in Table 1 We assumed a 10% lifetime risk of active TB in those with a positive IGRA, [22][23][24] 2% with positive TST, negative IGRA and 0.02% with negative IGRA and TST. [13,23] Using these, we estimated the expected total number of cases of active TB that would prospectively develop without LTBI testing and treatment (see Appendix Figure 1).…”

Section: Case Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

Cost effectiveness of testing HIV infected individuals for TB in a low TB/HIV setting

Capocci

Sewell

Smith

et al. 2020

Journal of Infection

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Section: Discussionmentioning

confidence: 99%

Section: Case Definitionsmentioning

confidence: 99%

Cost effectiveness of testing HIV infected individuals for TB in a low TB/HIV setting

Capocci

Sewell

Smith

et al. 2020

Journal of Infection

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“…Other studies assessing the predictive value in a low-endemic setting have found PPV of IGRA ranging from 0.8% in Portuguese healthcare workers22 and 2.4% among Dutch contacts who did not start preventive therapy8 to approximately 7%–8% in HIV positive10 23 to 28.6% in recently exposed children 21. Generally, above studies are limited by low number of incident TB cases ranging from 2 to 24 cases and variable design and follow-up periods 5 6 10 18 19 21 23. We have identified 40 incident cases in minimum 2 years of follow-up time, which makes this one of the largest cohorts studied.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Hermansen

Lillebæk

Kristensen

et al. 2016

Thorax

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“…Many of these 59 studies did not have the primary aim of assessing diagnostic accuracy. Many recorded few cases of active TB (often < 10) 22,[25][26][27][29][30][31][32][33][35][36][37][38]40,[42][43][44][45]47,48,50,51,[56][57][58][59][62][63][64][65][67][68][69][70][71][72][73][74][75]77,78 and/or were restricted to groups such as patients infected with HIV, 9,28,29,36,49,51,56,60,65,…”

Section: Diagnostic Performance Of Interferon Gamma Release Assays Fomentioning

confidence: 99%

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

Abubakar

Lalvani

Southern

et al. 2018

Health Technol Assess

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Background Despite a recent decline in the annual incidence of tuberculosis (TB) in the UK, rates remain higher than in most Western European countries. The detection and treatment of latent TB infection (LTBI) is an essential component of the UK TB control programme. Objectives To assess the prognostic value and cost-effectiveness of the current two interferon gamma release assays (IGRAs) compared with the standard tuberculin skin test (TST) for predicting active TB among untreated individuals at increased risk of TB: (1) contacts of active TB cases and (2) new entrants to the UK from high-TB-burden countries. Design A prospective cohort study and economic analysis. Participants and setting Participants were recruited in TB clinics, general practices and community settings. Contacts of active TB cases and migrants who were born in high-TB-burden countries arriving in the UK were eligible to take part if they were aged ≥ 16 years. Main outcome measures Outcomes include incidence rate ratios comparing the incidence of active TB in those participants with a positive test result and those with a negative test result for each assay, and combination of tests and the cost per quality-adjusted life-year (QALY) for each screening strategy. Results A total of 10,045 participants were recruited between May 2010 and July 2015. Among 9610 evaluable participants, 97 (1.0%) developed active TB. For the primary analysis, all test data were available for 6380 participants, with 77 participants developing active TB. A positive result for TSTa (positive if induration is ≥ 5 mm) was a significantly poorer predictor of progression to active TB than a positive result for any of the other tests. Compared with TSTb [positive if induration is ≥ 6 mm without prior bacillus Calmette–Guérin (BCG) alone, T-SPOT®.TB (Oxford Immunotec Ltd, Oxford, UK), TSTa + T-SPOT.TB, TSTa + IGRA and the three combination strategies including TSTb were significantly superior predictors of progression. Compared with the T-SPOT.TB test alone, TSTa + T-SPOT.TB, TSTb + QuantiFERON® TB Gold In-Tube (QFT-GIT; QIAGEN GmbH, Hilden, Germany) and TSTb + IGRA were significantly superior predictors of progression and, compared with QFT-GIT alone, T-SPOT.TB, TSTa + T-SPOT.TB, TSTa + QFT-GIT, TSTa + IGRA, TSTb + T-SPOT.TB, TSTb + QFT-GIT and TSTb + IGRA were significantly superior predictors of progression. When evaluating the negative predictive performance of tests and strategies, negative results for TSTa + QFT-GIT were significantly poorer predictors of non-progression than negative results for TSTa, T-SPOT.TB and TSTa + IGRA. The most cost-effective LTBI testing strategies are the dual-testing strategies. The cost and QALY differences between the LTBI testing strategies were small; in particular, QFT-GIT, TSTb + T-SPOT.TB and TSTb + QFT-GIT had very similar incremental net benefit estimates. Conclusion This study found modest differences between tests, or combinations of tests, in identifying individuals who would go on to develop active TB. However, a two-step approach that combined TSTb with an IGRA was the most cost-effective testing option. Implications for practice and future research The two-step TSTb strategy, which stratified the TST by prior BCG vaccination followed by an IGRA, was the most cost-effective approach. The limited ability of current tests to predict who will progress limits the clinical utility of tests. The implications of these results for the NHS England/Public Health England national TB screening programme for migrants should be investigated. Study registration This study is registered as NCT01162265. Funding The National Institute for Health Research Health Technology Assessment programme.

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6-year follow-up of 522 HIV-positive individuals screened forMycobacterium tuberculosisinfection in Denmark

Cited by 8 publications

References 10 publications

Cost effectiveness of testing HIV infected individuals for TB in a low TB/HIV setting

Cost effectiveness of testing HIV infected individuals for TB in a low TB/HIV setting

Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

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