A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong, Ngai Sze; Leung, Chi Chiu; Chan, Kenny Chi Wai; Chan, Wai Kit; Lin, Ada Wai Chi; Lee, Shui Shan

doi:10.1038/s41598-019-46570-5

Cited by 15 publications

(17 citation statements)

References 29 publications

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“…Median CD4/CD8 ratio at time of ART initiation in patients who developed incident TB in our cohort was similar to recent reports [18,44]. However, no significant difference in the average change of ratio over time on ART was seen in patients developing TB compared to patients remaining free of TB [44].…”

Section: Discussionsupporting

confidence: 89%

“…Cumulative findings have demonstrated that antiretroviral therapy (ART) reduces the risk of developing tuberculosis (TB) significantly [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Despite the advent of ART, however, TB remains the major cause of death and morbidity among patients co-infected with HIV-1 in sub-Saharan Africa (SSA) [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

Wolday

Kebede

Legesse³

et al. 2020

PLoS ONE

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Background The role of CD4/CD8 ratio on the incidence of tuberculosis (TB) in patients on antiretroviral therapy (ART) is unknown. Thus, we sought to determine whether the CD4/CD8 ratio was associated with development of TB in a cohort of HIV infected individuals on ART followed up for more than a decade in the setting of sub-Saharan Africa (SSA). Methods The cohort comprised adult patients who started ART between 2001 and 2007 and followed for up to 15 years. Clinical data were collected in retrospective manner. Patients with an AIDS defining illness or a CD4 count <200 cell/μL were started with a combination of ART. The participants have clinic visits every 6 months and/or as needed. Poisson regression models were used to identify factors associated with development of incident TB. Kaplan-Meier curves were used to estimate the probability of incident TB while on ART. Results A total of 347 patients with a median duration of follow-up on ART of 11.5 (IQR: 10.0-12.5) years were included. Incident TB developed in 47 patients during the 3259 person-years of follow-up, the majority (76.6%) occurred within five year of ART initiation. On univariate analysis,

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

Wolday

Kebede

Legesse³

et al. 2020

PLoS ONE

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“…Sixty-two cohorts reported the type of clinic where PLHIV were evaluated for TPT, and 40 (64%) of these cohorts were seen in HIV clinics. Twenty-one cohorts [ 17 , 66 – 79 ] did not use LTBI tests, while 49 cohorts [ 17 – 55 ] used LTBI tests; 22 used only TST, 12 used only IGRA, and 15 used either IGRA or TST. Among the 56 (80%) studies that reported the type of TPT regimen, mono-isoniazid regimens were the primary regimen prescribed in 50 cohorts (89%), and only one (2%) of the included cohorts primarily prescribed rifamycin-based short regimens (3 to 4 months of rifampicin and isoniazid) [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

et al. 2021

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Background Tuberculosis preventive therapy (TPT) reduces TB-related morbidity and mortality in people living with HIV (PLHIV). Cascade-of-care analyses help identify gaps and barriers in care and develop targeted solutions. A previous latent tuberculosis infection (LTBI) cascade-of-care analysis showed only 18% of persons in at-risk populations complete TPT, but a similar analysis for TPT among PLHIV has not been completed. We conducted a meta-analysis to provide this evidence. Methods and findings We first screened potential articles from a LTBI cascade-of-care systematic review published in 2016. From this study, we included cohorts that reported a minimum of 25 PLHIV. To identify new cohorts, we used a similar search strategy restricted to PLHIV. The search was conducted in Medline, Embase, Health Star, and LILACS, from January 2014 to February 2021. Two authors independently screened titles and full text and assessed risk of bias using the Newcastle–Ottawa Scale for cohorts and Cochrane Risk of Bias for cluster randomized trials. We meta-analyzed the proportion of PLHIV completing each step of the LTBI cascade-of-care and estimated the cumulative proportion retained. These results were stratified based on cascades-of-care that used or did not use LTBI testing to determine eligibility for TPT. We also performed a narrative synthesis of enablers and barriers of the cascade-of-care identified at different steps of the cascade. A total of 71 cohorts were included, and 70 were meta-analyzed, comprising 94,011 PLHIV. Among the PLHIV included, 35.3% (33,139/94,011) were from the Americas and 29.2% (27,460/94,011) from Africa. Overall, 49.9% (46,903/94,011) from low- and middle-income countries, median age was 38.0 [interquartile range (IQR) 34.0;43.6], and 65.9% (46,328/70,297) were men, 43.6% (29,629/67,947) were treated with antiretroviral therapy (ART), and the median CD4 count was 390 cell/mm3 (IQR 312;458). Among the cohorts that did not use LTBI tests, the cumulative proportion of PLHIV starting and completing TPT were 40.9% (95% CI: 39.3% to 42.7%) and 33.2% (95% CI: 31.6% to 34.9%). Among cohorts that used LTBI tests, the cumulative proportions of PLHIV starting and completing TPT were 60.4% (95% CI: 58.1% to 62.6%) and 41.9% (95% CI:39.6% to 44.2%), respectively. Completion of TPT was not significantly different in high- compared to low- and middle-income countries. Regardless of LTBI test use, substantial losses in the cascade-of-care occurred before treatment initiation. The integration of HIV and TB care was considered an enabler of the cascade-of-care in multiple cohorts. Key limitations of this systematic review are the observational nature of the included studies, potential selection bias in the population selection, only 14 cohorts reported all steps of the cascade-of-care, and barriers/facilitators were not systematically reported in all cohorts. Conclusions Although substantial losses were seen in multiple stages of the cascade-of-care, the cumulative proportion of PLHIV completing TPT was higher than previously reported among other at-risk populations. The use of LTBI testing in PLHIV in low- and middle-income countries was associated with higher proportion of the cohorts initiating TPT and with similar rates of completion of TPT.

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“…From our statistical analyses on the same data set, CD4 lymphocyte level, ART status, right of abode, and LTBI testing and treatment were important risk factors for TB development. 21 As the study population was relatively young, age by itself was not a significant risk factor for TB incidence. Tuberculosis reactivation rates by right of abode, ART status, CD4 lymphocyte level, and history of LTBI treatment were determined for model parameterization (eTable 3 in the Supplement).…”

Section: Methodsmentioning

confidence: 87%

“…In Hong Kong, nonlocal infections (inferred from infections in non-Chinese individuals and residents without right of abode) were also not significantly associated with positive subsequent LTBI tests. 21 To identify patients who had false-negative test results in previous LTBI tests, targeted subsequent LTBI tests by risk factor (strategy B), which cost less than annual testing strategy, might be an option. The risk-based testing strategy is currently recommended by the National Institute for Health and Care Excellence and the British HIV Association in the United Kingdom; this strategy involves testing HIV-positive individuals based on specific criteria, such as CD4 lymphocyte levels, country of origin, and ART duration.…”

Section: Discussionmentioning

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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A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Cited by 15 publications

References 29 publications

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

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

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