Risk assessment of tuberculosis in immunocompromised patients. A TBNET study.

Abstract

RATIONALE:

In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency.

OBJECTIVES:

This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis.

METHODS:

Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up.

MEASUREMENTS AND MAIN RESULTS:

Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy.

CONCLUSIONS:

Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs. Clinical trial registered with www.clinicaltrials.gov (NCT 00707317).

• Authors: Martina Sester, Frank van Leth, Judith Bruchfeld, Dragos Bumbacea, Daniela M Cirillo, Asli Gorek Dilektasli, José Domínguez, Raquel Duarte, Martin Ernst, Fusun Oner Eyuboglu, Irini Gerogianni, Enrico Girardi, Delia Goletti, Jean-Paul Janssens, Inger Julander, Berit Lange, Irene Latorre, Monica Losi, Roumiana Markova, Alberto Matteelli, Heather Milburn, Pernille Ravn, Theresia Scholman, Paola M Soccal, Marina Straub, Dirk Wagner, Timo Wolf, Aslihan Yalcin, Christoph Lange, TBNET
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 190 Issue 10 Pg. 1168-76 (Nov 15 2014) ISSN: 1535-4970 [Electronic] United States
• PMID: 25303140 (Publication Type: Controlled Clinical Trial, Journal Article)

Topics

• Adult
• Aged
• Arthritis, Rheumatoid (immunology)
• Cohort Studies
• Cross-Sectional Studies
• Female
• HIV Infections (immunology)
• Humans
• Immunocompromised Host
• Interferon-gamma Release Tests
• Kidney Failure, Chronic (immunology)
• Latent Tuberculosis (diagnosis)
• Male
• Middle Aged
• Organ Transplantation
• Risk Assessment
• Stem Cell Transplantation
• Tuberculin Test