Latent Tuberculosis Infection Screening and 2-Year Outcome in Antiretroviral-Naive HIV-Infected Patients in a Low-Prevalence Country

Abstract

Systematic screening for latent TB infection by IFN-γ release assay identifies a population at high risk of active TB over the next months. An extensive diagnostic work-up for active TB must follow positive IFN-γ release assay, before considering treatment of latent infection. Clinical trial registered with www.clinicaltrials.gov (NCT00805272).

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

“…There was no consistent association with the risk of LTBI for CD4 count, HIV viral load, or ART. Low CD4 count was not associated with an increased risk of LTBI among PLHIV, [10][11][12]17,22 and some studies (particularly those which used TSTs to diagnose LTBI) reported higher rates of LTBI in participants with high CD4 counts. 14,16,24,26 This is likely due to lower sensitivity of diagnostic tests for LTBI at lower CD4 counts, which is well documented for TSTs but less so for interferon-gamma release assays (IGRAs).…”

“…Homelessness, and living or working in a collective group or institution, were associated with higher risks of LTBI, 10,13,18,19 Proximity to persons with TB was also important; close contact with a TB case increased the risk of LTBI 10,11,19,21,45 and active TB, 25,29,40 and a study set in a prison demonstrated that closer proximity was associated with increased risk. 25…”

“…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. 14,17 However, a more recently published study stratified the risk of developing active TB by ethnicity and the TB incidence in country of birth and demonstrated that ethnicity and the incidence of TB in the patient's country of birth independently increase the risk of developing TB for PLHIV.…”

“…Age Greater risk with increasing age: 1 study 19 QFT-GIT-positive participants were significantly younger than QFT-GIT-negative participants: 1 study 11 No association: 11 studies 10,12,13,[16][17][18][21][22][23][24]45 Ethnicity Greater risk for black participants than white participants: 4 studies 15,17,19,23 Greater risk for Asian participants than white participants: 2 studies 13,17 Greater risk for Hispanic participants than white participants: 1 study 15 No association: 2 studies 18,22 Country of birth or residence Greater risk of LTBI in participants who were born abroad: 4 studies 13,21,23,24 Greater risk of LTBI in participants born in Africa: 3 studies 23,24,26 Greater risk for participants who were born or long-term residents in countries with high TB incidence: 7 studies [10][11][12]17,18,22,45 Risk of TB decreased with time since migration: 1 study 45 No association with visiting a TB-endemic country: 1 study 45…”

“…Greater risk for women: 2 studies 10,23 Greater risk for men: 1 study 24 No association: 9 studies [11][12][13][15][16][17][18]22,45 Single-sex studies: 4 studies 14,19,21,25 Pregnancy No association: 1 study 19 All participants were pregnant: 1 study 21…”