Active and latent tuberculosis among HIV‐positive injecting drug users in Indonesia

Abstract

IntroductionInjecting drug use (IDU) is associated with tuberculosis but few data are available from low-income settings. We examined IDU in relation to active and latent tuberculosis (LTBI) among HIV-positive individuals in Indonesia, which has a high burden of tuberculosis and a rapidly growing HIV epidemic strongly driven by IDU.MethodsActive tuberculosis was measured prospectively among 1900 consecutive antiretroviral treatment (ART)-naïve adult patients entering care in a clinic in West Java. Prevalence of LTBI was determined cross-sectionally in a subset of 518 ART-experienced patients using an interferon-gamma release assay.ResultsPatients with a history of IDU (53.1%) more often reported a history of tuberculosis treatment (34.8% vs. 21.9%, p<0.001), more often received tuberculosis treatment during follow-up (adjusted HR=1.71; 95% CI: 1.25–2.35) and more often had bacteriologically confirmed tuberculosis (OR=1.67; 95% CI: 0.94–2.96). LTBI was equally prevalent among people with and without a history of IDU (29.1 vs. 30.4%, NS). The risk estimates did not change after adjustment for CD4 cell count or ART.ConclusionsHIV-positive individuals with a history of IDU in Indonesia have more active tuberculosis, with similar rates of LTBI. Within the HIV clinic, LTBI screening and isoniazid preventive therapy may be prioritized to patients with a history of IDU.

Good Agreement between an Interferon Gamma Release Assay and Tuberculin Skin Tests in Testing for Latent Tuberculosis Infection among HIV-Infected Patients in Indonesia

“…In this study, TST and T-SPOT.TB detected latent tuberculosis infection in 19% and 18% of the participants, respectively. A study of latent tuberculosis among drug-users with HIV infection in Indonesia revealed a prevalence of 29% using QuantiFERON Gold In-Tube assay, another type of IGRA 21. This prevalence is higher than that found in our study using T-SPOT.TB.…”

“…This prevalence is higher than that found in our study using T-SPOT.TB. The higher prevalence could be attributable to the different type of IGRA that was used, the higher proportion of participants who had household exposure to tuberculosis (10%–30%), and the high proportion of participants who had previously been treated for tuberculosis (approximately 40%) 21…”

Factors associated with treatment for latent tuberculosis in persons living with HIV/AIDS

“…In Quebec city, Canada, primary care physicians initiated a substantial number of LTB i treatments, but less than half of patients completed treatment regardless of the physician specialty. Primary care physicians should be supported to enhance treatment completion 25 . PLWHA present a much higher risk of developing TB than the general population and deserve more attention when receiving treatment for LTB i 17 .…”

Infecção latente por tuberculose entre pessoas com HIV/AIDS, fatores associados e progressão para doença ativa em município no Sul do Brasil

“…De fato, observa-se que as duas infecções, TB e HIV/AIDS, apresentam predominância entre o gênero masculino 34,35 , semelhantemente à prevalência da ILTB que tem sido elevada neste gênero 11,12 . Os resultados podem ser justificados devido a, frequentemente, os homens serem associados à menor adoção de ações de promoção e prevenção em saúde e, por sua parte, menor procura por serviços de saúde 36 , vindo a adoecer e até morrer por doenças como a TB e AIDS 34,35 .…”

“…No que tange aos fatores associados à ILTB em PVHA, alguns estudos apontam o etilismo 11 , o uso de drogas injetáveis 12 , estágio avançado do HIV, ambientes insalubres e gênero feminino 13 . Outra questão emblemática diz respeito à instituição do tratamento entre os casos de ILTB; na literatura há relatos de pacientes que, mesmo com diagnóstico de ILTB, desenvolveram TB ativa, pois não foram indicados à terapia com isoniazida 14 ; outro fator determinante para adoecimento das PVHA é a não instituição precoce e uso regular da terapia antirretroviral (TARV), sendo que esta terapia pode reduzir em até 51% as chances de desenvolver a TB ativa 15 .…”