Strategy to better select HIV-infected individuals for latent TB treatment in BCG-vaccinated population.

Abstract

OBJECTIVE:

To evaluate the T-SPOT.TB interferon-γ releasing assay and the tuberculin skin test (TST), for the diagnosis of latent tuberculosis infection(LTBI) and the development of subsequent active tuberculosis, in BCG-vaccinated HIV-infected individuals.

METHODS:

HIV-infected individuals without clinical suspicion of active TB or a past history of TB were enrolled from 1 January 2008 to 30 November 2010. Both T-SPOT.TB test and TST were offered to the participants whom were followed up prospectively until April 30, 2012 for development of TB.

RESULTS:

Among the 909 participants, 25% had positive TST reactions with cut-off point of 5 mm and 15% had positive T-SPOT.TB results. After a median follow-up of 2.97 years, there were 5 cases developed culture-confirmed active TB (all had dual positive TST and T-SPOT.TB results), and the incidence was 0.17 per 100 person-years. The relative risks (RRs) for subsequent active TB in HIV-infected individuals with positive TST results, positive T-SPOT.TB results and dual positive results compared with the risk for individuals with negative results were 40.6 (95% CI 2.1-767.9), 73.9 (95% CI 3.9-1397.7) and 226.5 (95% CI 12.0-4284), respectively. The number needed to treat to prevent one subsequent TB case among patients with a positive TST, a positive T-SPOT.TB and dual positive results was 35, 22 and 8 respectively.

CONCLUSIONS:

Adopting positive results of the TST and T-SPOT.TB to screen LTBI among BCG-vaccinated HIV-infected individuals might be feasible. Number needed to treat for isoniazid preventive therapy could be reduced significantly by using dual positive strategy.

• Authors: Chin-Hui Yang, Pei-Chun Chan, Say-Tsung Liao, Shu-Hsing Cheng, Wing-Wai Wong, Li-Min Huang, Po-Ren Hsueh, Hung-Yi Chiou
• Journal: PloS one (PLoS One) Vol. 8 Issue 8 Pg. e73069 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 24015285 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antitubercular Agents
• Isoniazid

Topics

• Adult
• Aged
• Aged, 80 and over
• Antitubercular Agents (administration & dosage)
• Female
• Follow-Up Studies
• HIV Infections
• Humans
• Isoniazid (administration & dosage)
• Latent Tuberculosis (diagnosis, drug therapy)
• Male
• Middle Aged
• Mycobacterium bovis
• Tuberculin Test