Screening and treatment of latent tuberculosis infection among HIV-infected patients in resource-rich settings

Lin, Ada Wai Chi; Lau, Susanna K.P.; Woo, Patrick C. Y.

doi:10.1586/14787210.2016.1168693

Cited by 10 publications

(13 citation statements)

References 53 publications

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“…The compliance figures of LTBI screening in Hong Kong (84%) appeared to be higher than that of other developed countries (<70%) 11–13,15 . Nonetheless, the prevalence of LTBI in this study (32%) was similar to nearby Asian places (Iran, Korea, Thailand, Taiwan) 21,22 , and the proportion of TB cases with LTBI testing history (56%) was close to that of a Canadian study (61%) 14 .…”

Section: Discussionsupporting

confidence: 75%

“…The improvement of immune status after HAART initiation could reduce the probability of false negative LTBI testing results. The positive rate of LTBI at very low CD4 level (<100/μL) was particularly low, as shown also in a multicentre European cohort study and other studies 21,35 . We observed a rise of positive LTBI rate in association with the improving immune status (CD4 and CD4/CD8 ratio) among patients in both the first and subsequent LTBI tests.…”

Section: Discussionsupporting

confidence: 68%

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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: 75%

Section: Discussionsupporting

confidence: 68%

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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“…infection or reactivation in case of latent TB ( 22 ). HIV-infected individuals are 26 times more likely to be diagnosed with TB in comparison with those non-HIV infected ( 59 ). As M.tb.…”

Section: Discussionmentioning

confidence: 99%

Screening performance of C-reactive protein for active pulmonary tuberculosis in HIV-positive patients: A systematic review with a meta-analysis

et al. 2022

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BackgroundTuberculosis (TB) is the leading infectious cause of mortality worldwide. In the last years, resistant strains of the etiological agent, Mycobacterium tuberculosis, have emerged, thus demanding more triage tests to identify active pulmonary TB (PTB) patients and to evaluate their disease severity. Therefore, acute-phase reaction serum tests are required for monitoring TB patients, among WHO symptom screening recommendations. C-reactive protein (CRP) is a non-specific inflammatory biomarker that has been recently proposed for TB screening and can be quantitatively analyzed through cost-effective point-of-care assays. A previous meta-analysis found CRP to be highly sensitive and moderately specific for active PTB with confirmed HIV infection.MethodsWe performed a meta-analysis update of diagnostic tests, pooling sensitivities, and specificities in order to assess the accuracy of CRP as a potential test for the screening of HIV-associated PTB in outpatients. We searched MEDLINE, Web of Science, and SCOPUS for eligible articles before 19 October 2021.ResultsWe identified 13 eligible studies with HIV-positive patients with PTB. At a CRP threshold of 10 mg/L, CRP pooled sensitivity was 87% (76%–93%) and pooled specificity was 67% (49%–81%), with an area under the curve (AUC) of 0.858. Using a CRP threshold of 8 mg/L, pooled sensitivity was 82% (72%–89%) and pooled specificity was 82% (67%–92%), with an AUC of 0.879. We found that CRP has a high sensitivity in the screening of PTB in HIV-positive outpatients, consistent with findings reported previously.ConclusionsRegardless of pooled specificity, better results were found using the CRP threshold of 8 mg/L as a test screening of PTB, meeting the need of further approaching specific TB diagnostic methods and reducing resource consumption.

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“…Cases that had positive LTBI results in subsequent tests would be offered LTBI treatment. Model parameters and equations are shown in the eAppendix, eTable 1, 2,3,16,17,18,19,20 eTable 2, and eFigures 2-6 in the Supplement.…”

Section: Methodsmentioning

confidence: 99%

Latent Tuberculosis Infection Testing Strategies for HIV-Positive Individuals in Hong Kong

et al. 2019

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Key PointsQuestionIn a setting with low HIV-tuberculosis incidence, is repeated testing for latent tuberculosis infection (LTBI) cost-effective for managing individuals with HIV who have negative LTBI test results at baseline?FindingsIn this decision analytical model using a cost-effectiveness analysis, based on 3130 HIV-positive individuals in Hong Kong, China, a strategy of baseline LTBI testing followed by up to 3 subsequent annual tests could avert a similar proportion of new tuberculosis infections while incurring a lower cost compared with annually repeated testing. The strategy did not meet the willingness-to-pay threshold but would likely be cost-effective if the threshold were raised.MeaningThe findings suggest that less intense subsequent LTBI testing strategies may be effective and are likely cost-effective.

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Screening and treatment of latent tuberculosis infection among HIV-infected patients in resource-rich settings

Cited by 10 publications

References 53 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

Screening performance of C-reactive protein for active pulmonary tuberculosis in HIV-positive patients: A systematic review with a meta-analysis

Latent Tuberculosis Infection Testing Strategies for HIV-Positive Individuals in Hong Kong

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