Is systematic screening and treatment for latent tuberculosis infection in HIV patients useful in a low endemic setting?

Maniewski, Ula; Payen, Marie-Christine; Delforge, Marc; Wit, Stéphane De

doi:10.1080/17843286.2016.1237696

Cited by 6 publications

(13 citation statements)

References 25 publications

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“…In our study, there was a drop of TB incidence (in HIV care) by three-folds following HAART initiation. Patients with higher CD4 and/or CD4/CD8 ratio were at lower risk of TB disease development, as observed in our and previous studies 24,27,28 , as a result of immune recovery 18,19 . The results were consistent with those reported in a study showing the four times higher TB incidence among heterosexual HIV patients not on HAART 29 , and conclusion from a systematic review 19 .…”

Section: Discussionsupporting

confidence: 89%

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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Latent TB infection (LTBI) in HIV patients, its treatment, and immunological recovery following highly active antiretroviral therapy (HAART) could interact and impact TB disease progression. We aim to examine the factors associated with LTBI and TB disease development among HIV patients. Longitudinal clinical and laboratory data were accessed from the largest HIV specialist clinic in Hong Kong, where HAART and yearly LTBI screening are routinely provided for HIV patients. Between 2002 and mid-2017, among 2079 HIV patients with 14119 person-years (PY) of follow-up, 32% of LTBI screened patients (n = 1740) were tested positive. The overall TB incidence was 1.26/100 PY from HIV diagnosis to HAART initiation, falling to 0.37/100 PY. A lower risk of TB disease progression was associated with local residence, Chinese ethnicity, negative baseline LTBI result, being on HAART, LTBI treatment, higher baseline CD4 and CD4/CD8 ratio. A positive test at baseline, but not subsequent testing results, was significantly associated with TB disease development. Baseline LTBI screening is an important strategy for identifying HIV patients at risk of TB disease progression. Routine repeat LTBI screening on an annual basis might not give additional benefits to patients on HAART with good immunological responses. Such practice should require re-evaluation.

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Section: Discussionsupporting

confidence: 89%

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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“…Year of diagnosis Greater risk among those who entered the cohort later: 1 study 27 Greater risk of TB if diagnosing with HIV during the ART era than prior to ART being introduced: 1 study 41 No association: 3 studies 31,51,54 CD4 count Greater risk at lower CD4 count: 22 studies 23,24,27,28,[30][31][32][33][34][35][36][37][38]40,[42][43][44]46,[49][50][51][52] No association: 3 studies 25,26,39 Viral load Greater risk with higher viral load: 9 studies 23,24,27,31,32,35,36,43,44 No association: 6 studies 25,34,37,49,51,54 Anti-retroviral therapy Lower risk for patients on ART: 10 studies 23,24,…”

Section: Risk Factor For Ltbi Summary Of Resultsmentioning

confidence: 99%

“…We found that the risk of both LTBI and active TB was greatest among PLHIV from ethnic minorities; particularly those of black African, South Asian or Hispanic ethnicity. 13,15,17,19,23,25,31,32,37,43,44,46,49,52,53 Similarly, PLHIV who were born in, or long-term residents of, countries with high TB incidence had higher rates of LTBI and active TB. [10][11][12][13]17,18,[22][23][24]26,45,56 Few studies examined the effects of country of birth and ethnicity independently of each other; those that did found no independent associations between ethnicity and country of birth and active TB 34,46 or LTBI.…”

Section: Ethnicity and Country Of Birthmentioning

confidence: 99%

“…CD4 counts of <500 cells/µl were overwhelmingly inversely associated with greater risk of developing active TB. 23,24,27,28,30,31,[33][34][35][36][37][38][42][43][44]46,[49][50][51] ART was highly protective against active TB for PLHIV, 24,27,30,34,35,46,51 with a time-dependent decrease in risk of TB during ART documented in multiple studies. 27,31,43,44 Conversely, though the data were conflicting, high viral loads were associated with increased risk of active TB in most studies.…”

Section: Clinical Risk Factors For Hiv-tb Cd4 Count Viral Load and Artmentioning

confidence: 99%

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Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence

Winter

et al. 2018

int j tuberc lung dis

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In countries with low tuberculosis (TB) incidence, TB is concentrated in vulnerable populations, including people living with the human immunodeficiency virus (PLHIV), who have a substantially greater risk of TB than people without HIV. We searched PubMed, EMBASE and Web of Science for studies evaluating the risk factors for latent tuberculous infection (LTBI) or active TB in PLHIV in countries with TB incidence 10 per 100 000 population. Due to the number of risk factors evaluated and heterogeneity in study designs, we present summary data and a narrative synthesis. We included 45 studies: 17 reported data on the risk factors for LTBI and 32 on active TB. Black, Asian or Hispanic ethnicity, birth or long-term residence in a country with high TB incidence, and HIV acquisition via injecting drug use (IDU) or heterosexual sex were strong predictors of both LTBI and active TB. History of contact, a greater degree of immunosuppression at diagnosis or higher viral load increased the TB risk. Early HIV diagnosis to allow timely initiation of antiretroviral therapy is essential for the prevention of TB in PLHIV. Screening and treating PLHIV for LTBI to reduce the risk of progression to active TB disease should also be considered to further reduce the burden of active TB in low TB incidence settings. Research to support the expansion of TB and HIV prevention and treatment globally is essential to eliminate TB in low-incidence settings.

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“…More radically, Dr Maniewsky suggested screening only patients from TB-endemic countries with a nadir (lowest-ever) CD4+ T-cell count <200 cells/mm 3 . This strategy is based on a retrospective study of 1140 HIV-infected patients entering the Brussels St Pierre cohort between 2005 and 2012, and showing that of the 42 patients that would develop TB during follow-up, 83% were of African origin and 60% had a nadir CD4 T-cell count <200 cells/mm 3 [13].…”

Section: Introductionmentioning

confidence: 99%

Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting

et al. 2015

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The screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.

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Is systematic screening and treatment for latent tuberculosis infection in HIV patients useful in a low endemic setting?

Cited by 6 publications

References 25 publications

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence

Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting

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