Underestimation of Mycobacterium tuberculosis infection in HIV-infected subjects using reactivity to tuberculin and anergy panel

García-García, Ma. de Lourdes; Valdespino-Gómez, José Luis; García-Sancho, Cecilia; Mayar-Maya, Ma. Eugenia; Palacios-Martínez, Manuel; Balandrano-Campos, Susana; Escobar‐Gutiérrez, Alejandro; Peruga, Armando; Weissenbacher, Mercedes; Daniels, Elaine

doi:10.1093/ije/29.2.369

Cited by 28 publications

(5 citation statements)

References 14 publications

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“…In HIV infected persons, there is a concern that, similarly to the TST [28] , the performance of the test could be impaired due to anergy associated with decreasing CD4 cell counts resulting in false negative ELISPOT responses [26] . The performance of whole-blood cytokine assays for the diagnosis of LTBI in HIV positive versus HIV-negative patients has previously been assessed in two small studies in Africa, with conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity of IFN-γ Release Assay to Detect Latent Tuberculosis Infection Is Retained in HIV-Infected Patients but Dependent on HIV/AIDS Progression

et al. 2008

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BackgroundDetection and treatment of latent TB infection (LTBI) in HIV infected individuals is strongly recommended to decrease morbidity and mortality in countries with high levels of HIV.ObjectiveTo assess the validity of a newly developed in-house ELISPOT interferon-γ release assay (IGRA) for the detection of LTBI amongst HIV infected individuals, in comparison with the Tuberculin Skin Test (TST).Methodology/Principal FindingsESAT6/CFP10 (EC) ELISPOT assays were performed, together with a TST, in 285 HIV infected individuals recruited in HIV clinics in Dakar, Senegal, who had no signs of active TB at time of enrolment. Thirty eight of the subjects (13.3%) failed to respond to PHA stimulation and were excluded from the analysis. In the 247 remaining patients, response to PHA did not vary according to CD4 cell count categories (p = 0.51). EC ELISPOT was positive in 125 (50.6%) subjects, while 53 (21.5%) had a positive TST. Concordance between EC ELISPOT and TST was observed in 151 patients (61.1%) (kappa = 0.23). The proportion of subjects with a positive response to the EC ELISPOT assay decreased with declining CD4 counts (p trend = 0.001), but were consistently higher than the proportion of TST responders. In multivariate analysis, the risk of being EC-ELISPOT positive in HIV infected individuals was associated with age, CD4 count and HIV-1 strain.ConclusionOur study indicates that IGRAs using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals, but may be impaired by T-cell anergy in severely immuno-suppressed individuals.

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Section: Discussionmentioning

confidence: 99%

Sensitivity of IFN-γ Release Assay to Detect Latent Tuberculosis Infection Is Retained in HIV-Infected Patients but Dependent on HIV/AIDS Progression

et al. 2008

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“…In other settings, approximately 3-quarters of PLHIV screened in TB-endemic settings were documented as TST-negative 7,13,41,42 and are unlikely to benefit from IPT. Additionally, they may be subjected to the adverse effects of IPT.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Operational Research

Smith

Samandari

Abimbola³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective In Botswana, a 36-month course of isoniazid treatment of latent tuberculosis (TB) infection [isoniazid preventive therapy (IPT)] was superior to 6-month IPT in reducing TB and death in persons living with HIV (PLHIV), having positive tuberculin skin tests (TSTs) but not in those with negative TST. We examined the cost-effectiveness of IPT in Botswana, where antiretroviral therapy (ART) is widely available. Design Using a decision-analytic model, we determined the incremental cost-effectiveness of strategies for reducing TB and death in 10,000 PLHIV over 36 months. Methods IPT for 6 months and provision of ART if CD4+ lymphocyte count <250 cells per microliter (2011 Botswana policy) was compared with 6 alternative strategies that varied the use of IPT, TST, and ART for CD4+ count thresholds, including CD4+ <350 and <500 cells per microliter. Results Botswana policy, 2011 was dominated by most other strategies. IPT of 36 months for TST-positive PLHIV with ART for CD4+ <250 cells per microliter resulted in 120 fewer TB cases for an additional cost of $1612 per case averted and resulted in 80 fewer deaths for an additional $2418 per death averted compared with provision of 6-month IPT to TST-positive PLHIV who received ART for CD4+ <250 cells per microliter, the next most effective strategy. Alternative strategies offered lower incremental effectiveness at higher cost. These findings remained consistent in sensitivity analyses. Conclusions A strategy of treating PLHIV who have positive TST with 36-month IPT is more cost effective for reducing both TB and death compared with providing IPT without a TST, providing only 6-month IPT, or expanding ART eligibility without IPT.

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“…The positive Mantoux test in spite of low CD4 count did add to diagnostic dilemma. But PPD positivity not only depends on CD4 count but also on the BCG scar (i.e., previous immunization status) and age of the child [7]. Moreover studies often failed to show significant correlation between CD4 count and PPD positivity [8,9].…”

Section: Discussionmentioning

confidence: 99%

HIV encephalopathy masquerading as infantile stroke syndrome: Treatment after antiretroviral did wonders

Kundu

Samanta

Bhattacharyya

2015

J Pediatr Infect Dis

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We present a case report of a young child with fever for 2 weeks followed by ataxia, spastic quadriparesis, aphasia with bulbar palsy, and lastly loss of consciousness. All symptoms developed within a span of 5 days. Provisional diagnosis of infantile stroke due to infective vasculitis was made. Cranial computed tomography revealed multiple infarctions with bilateral dilated ventricles and mild cortical atrophy. Based on cerebrospinal fluid analysis, contact history and Mantoux test, anti-tubercular therapy was started. Therapeutic failure led to a suspicion of immunosuppression. So, opportunistic infections of central nervous system along with neurotuberculosis were ruled out by relevant standard tests. Subsequently human immunodeficiency virus encephalopathy was diagnosed and highly active antiretroviral therapy was initiated immediately. Neurological abnormalities reversed and complete radiological clearance was noted with highly active antiretroviral therapy within 1 year. The unusual presentation, rare neuroimaging findings, and dramatic response make this case notable.

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Underestimation of Mycobacterium tuberculosis infection in HIV-infected subjects using reactivity to tuberculin and anergy panel

Cited by 28 publications

References 14 publications

Sensitivity of IFN-γ Release Assay to Detect Latent Tuberculosis Infection Is Retained in HIV-Infected Patients but Dependent on HIV/AIDS Progression

Sensitivity of IFN-γ Release Assay to Detect Latent Tuberculosis Infection Is Retained in HIV-Infected Patients but Dependent on HIV/AIDS Progression

Implementation and Operational Research

HIV encephalopathy masquerading as infantile stroke syndrome: Treatment after antiretroviral did wonders

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