The Relationship Between Latent Tuberculosis Infection and Acute Myocardial Infarction

Huamán, Moisés A.; Ticona, Eduardo; Miranda, Gara; Kryscio, Richard J.; Mugruza, Raquel; Aranda, Ernesto; Taype‐Rondan, Alvaro; Henson, David; Ticona, César; Sterling, Timothy R.; Fichtenbaum, Carl J.; Garvy, Beth A.

doi:10.1093/cid/cix910

Cited by 55 publications

(73 citation statements)

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“…There were 120 (56%) persons with LTBI and 94 (44%) persons without LTBI based on QFT results. Participant characteristics were not significantly different between the LTBI and non-LTBI groups except for recent AMI ( Table 1 ), which was more frequent in the LTBI group as previously reported [ 16 ].…”

Section: Resultssupporting

confidence: 72%

“…Persons with history of human immunodeficiency virus (HIV) infection, TB disease, and/or LTBI treatment were excluded. A detailed description of the recruiting parameters were previously published [ 16 ]. Participants’ demographic information and medical history were collected by self-report.…”

Section: Methodsmentioning

confidence: 99%

“…Participants with indeterminate QFT results were excluded from this study. Primary results of the QFT test based on the response to TB antigens were presented previously [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Using data from the U.S. National Health Nutritional Examination Survey (NHANES), we previously reported an association between LTBI and elevated unstimulated blood levels of interferon-gamma (IFN-γ), a central cytokine in monocyte/macrophage activation usually produced by activated T cells and natural killer cells [ 15 ]. To further assess this finding, we performed a secondary analysis of IFN-γ levels in participants of a cardiovascular disease study conducted in Peru, who underwent LTBI testing via the QuantiFERON® TB Gold-In tube (QFT) assay [ 16 ]. By studying this population, we sought to examine IFN-γ levels in a setting where M .…”

Section: Introductionmentioning

confidence: 99%

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Latent tuberculosis infection is associated with increased unstimulated levels of interferon-gamma in Lima, Peru

et al. 2018

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BackgroundWe previously reported increased unstimulated blood levels of interferon-gamma in persons with latent tuberculosis infection (LTBI) in the United States, suggesting enhanced immune activation in LTBI. To investigate this further in a TB-endemic setting, we assessed interferon-gamma levels in persons with and without LTBI in Peru.MethodsWe analyzed data from patients with and without a recent type 1 (spontaneous) acute myocardial infarction (AMI) who were enrolled from two public hospital networks in Lima, Peru, and underwent LTBI testing using the QuantiFERON® TB Gold In-tube (QFT) assay. Participants with a positive QFT test were defined as having LTBI, whereas participants with a negative QFT test were defined as non-LTBI. Unstimulated interferon-gamma was quantified via enzyme-linked immunosorbent assay in the QFT nil-tube, which does not contain antigens. We compared unstimulated interferon-gamma levels between LTBI and non-LTBI groups using the Wilcoxon rank sum test. We used proportional odds modeling for multivariable analysis.ResultsData from 214 participants were included in this analysis. Of those, 120 (56%) had LTBI. There were no significant differences in age, sex and comorbidities between LTBI and non-LTBI participants, except for recent AMI that was more frequent in LTBI. LTBI participants had higher unstimulated interferon-gamma levels compared to non-LTBI participants (median, interquartile range; 14 pg/mL, 6.5–52.8 vs. 6.5 pg/mL, 4.5–15; P<0.01). LTBI remained associated with higher unstimulated interferon-gamma levels after controlling for age, sex, recent AMI, history of hypertension, diabetes mellitus, dyslipidemia, end stage renal disease, malignancy, obesity, and tobacco use (adjusted odds ratio, 2.93; 95% confidence interval, 1.8–4.9). In a sensitivity analysis that excluded participants with AMI, the association between unstimulated interferon-gamma and LTBI remained present (adjusted odds ratio; 3.93; 95% confidence interval, 1.9–8.2).ConclusionsLTBI was associated with higher unstimulated interferon-gamma levels. These data suggest ongoing immune activation in LTBI.

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Section: Resultssupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

“…Participants with indeterminate QFT results were excluded from this study. Primary results of the QFT test based on the response to TB antigens were presented previously [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Latent tuberculosis infection is associated with increased unstimulated levels of interferon-gamma in Lima, Peru

et al. 2018

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“…Most studies have described an association between hypertension and older age, male sex and elevated body mass index but not with HIV‐specific risk factors . Two studies have described an association between incident hypertension and ART exposure or nadir CD4 , and data are emerging regarding the association between tuberculosis and CVD risk . Because early initiation of ART is now recommended for all PWH given its clinical and prevention benefits, the exact relationship between immunosuppression, ART exposure and hypertension incidence may be less relevant as all patients will be encouraged to start ART upon diagnosis .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular risk factors among ART‐experienced people with HIV in South Africa

et al. 2019

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Introduction People with HIV ( PWH ) are at increased risk for atherosclerotic cardiovascular disease ( CVD ). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment ( ART )‐experienced patients in South Africa. Methods We performed a prospective, observational cross‐sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure ( BP ) measurements and random/fasting glucose via a point‐of‐care glucometer. Standardized chart reviews provided individuals' HIV ‐specific data. We defined hypertension as: self‐reported use of antihypertensives or mean systolic BP ( SBP ) ≥140 mmHg or diastolic BP ( DBP ) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self‐reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios ( RR ) for hypertension from a multivariable log‐binomial regression model, adjusting for age, sex and diabetes. Results From March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range ( IQR ) 33 to 44 years) and median CD 4 466/μL ( IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency ( BP ≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension ( RR , 1.04; 95% CI , 1.03 to 1.06, p < 0.0001) in the multivariable model. Conclusions Hypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagn...

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Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

et al. 2018

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Among patients with TB disease, the development of stress hyperglycemia may influence the clinical manifestation and treatment response of some patients and can complicate diabetes diagnosis. Research is needed to elucidate the relationship between TB disease and stress hyperglycemia and determine the extent to which stress hyperglycemia impacts TB treatment response. Currently, there is insufficient data to support clinical recommendations for glucose control among patients with TB disease, representing a major barrier for efforts to improve treatment outcomes for patients with TB and diabetes.

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The Relationship Between Latent Tuberculosis Infection and Acute Myocardial Infarction

Abstract: LTBI was independently associated with AMI. Our results suggest a potentially important role of LTBI in CVD.

Cited by 55 publications

References 39 publications

Latent tuberculosis infection is associated with increased unstimulated levels of interferon-gamma in Lima, Peru

Latent tuberculosis infection is associated with increased unstimulated levels of interferon-gamma in Lima, Peru

Cardiovascular risk factors among ART‐experienced people with HIV in South Africa

Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

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