Interferon-gamma release assay versus tuberculin skin test for latent tuberculosis infection among HIV patients in Brazil

Kussen, Gislene Maria Botão; Dalla-Costa, Líbera Maria; Vilela, Carlos Ribeiro; Raboni, Sônia Mara

doi:10.1016/j.bjid.2015.10.007

Cited by 22 publications

(21 citation statements)

References 27 publications

(40 reference statements)

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“…We found the results of the TST and QFT-Plus tests to be in poor agreement (0.225), which is similar to what others have found [31,[33][34][35][36][37][38]. The accuracy measures of the TST are often confounded by BCG vaccination and non-tuberculous mycobacterial (NTM) infections [39], [14].…”

Section: Discussionsupporting

confidence: 76%

“…The higher prevalence of LTBI seen in the TST is likely due to falsepositive results attributed by nontuberculous mycobacterium (NTM) infection and prior BCG vaccination [15, [28][29][30]. In Sub-Saharan Africa, where the Bacillus Calmette-Guérin vaccine is administered at birth, the TST will be affected by vaccination, which is not the case with IGRAs [31,32].…”

Section: Discussionmentioning

confidence: 99%

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Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Kadima

Lutumba

Kaswa³

et al. 2019

Preprint

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Background The World Health Organization (WHO) End Tuberculosis Strategy calls for a 90% reduction in tuberculosis (TB) deaths and an 80% reduction in the incidence rate between 2015 and 2035. The 2018 WHO guidelines recognize the need for high-burden countries to implement outreach and treatment for the most vulnerable patients with latent TB infection (LTBI) in addition to treating patients with the active disease. The Democratic Republic of Congo (DR Congo) is among the countries bearing the highest burden of TB. However, additional data on LTBI is required for effective policy and strategy against the disease. Accordingly, the aim of this study is to estimate the prevalence of LTBI in HIV-infected adults in Kinshasa, DR Congo. Methods Over two hundred HIV-infected adult residents of Kinshasa were screened using both TUBERTEST®, which is a tuberculin skin test (TST), and QuantiFERON-TB Gold Plus® (QFT-Plus), which is an interferon gamma release assay. LTBI was screened using TST, QFT-Plus, and a combination of the two tests. The agreement between TST and QFT-Plus was calculated using Cohen’s Kappa coefficient. Results A total of 248 HIV-infected persons were enrolled in the study. Seventy-six patients (30.7% IC 95%: 25.2-36.7) had a positive TST result. Sixty-four (25.8% IC 95%: 20.7-31.6) had a positive QFT-Plus test result. The Kappa coefficient between TST and QFT-Plus was 0.225. Conclusions The prevalence of LTBI among HIV positive adults in Kinshasa was high considering either the positive TST or the positive QFT-Plus. However, the two tests had poor agreement.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Kadima

Lutumba

Kaswa³

et al. 2019

Preprint

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“…Strategies to further improve access and adherence to PTI have been explored by several authors, including shorter duration regimens, use of digital technologies to improve adherence and retention in care, use of simplified treatment regimens or use of regimens with better tolerance [36][37][38] . In addition, access to PTI could be improved with the implementation of the interferon-γ release assay testing in settings with scarcity of TST or whenever an additional visit to the clinic to assess the TST result is not feasible 39 . The burden of TB-associated morbidity and mortality among PLHIV highlights the need for a comprehensive management of latent TB diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

Access and adherence to isoniazid preventive therapy and occurrence of active TB in a cohort of people living with HIV: a retrospective cohort study in Sao Paulo, Brazil

Picone

Freitas

Gutierrez

et al. 2020

Rev. Inst. Med. trop. S. Paulo

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Tuberculosis (TB) is still a leading cause of morbidity and mortality among people living with HIV (PLHIV). The diagnosis of latent TB is required for the implementation of prophylactic therapy with isoniazid (PTI). However, low access to diagnosis of latent TB and non-adherence to PTI may hinder potential benefits of this essential intervention. In this study, we addressed the access and adherence to PTI in a cohort of PLHIV with positive tuberculin skin test (TST) in a reference HIV clinic in Sao Paulo, Brazil. We have also analyzed the occurrence of active TB over a median of 131 months after a positive TST among study participants. Our findings revealed that 88.3% of the 238 TST-positive patients had access to PTI, and 196 (93.3%) of those with access adhered to PTI. Active tuberculosis was diagnosed in three of the 196 TST-positive patients who adhered to PTI (1.5%; 95% confidence interval [CI] 0.3-4.4%), whereas seven cases were detected among 42 patients without access or who did not adhere to PTI (16.6%; 95% CI 7.0-31.3%). The apparent beneficial effect of PTI in our cohort is consistent with previous studies including PLHIV, and highlights the importance of reliably delivering each of the steps between screening for latent TB and provision of PTI.

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“…Dessa forma, o percentual de ILTB pode ser reflexo da presença da TB e os resultados encontrados no presente trabalho justificam-se devido ao cenário da pesquisa 19,22 . O município do estudo foi considerado prioritário para o controle da TB pelo Ministério da Saúde quando apresentava incidência de 27,6 casos por 100 mil habitantes em 2006; em 2014 o mesmo foi removido da lista de prioritários por atender as metas de controle da doença e ter atingido uma incidência de 20,6 casos por 100 mil habitantes 4 Chama a atenção que o tratamento da ILTB tenha sido despendido a apenas 39 (59%) dos indivíduos com esta infecção, bem como o abandono ter chegado a 25,6%, visto que estudos apontam o início do tratamento em 69,8% das pessoas elegíveis 11 e abandono de 2,2% 5 , resultados melhores quando comparados aos do presente trabalho.…”

Section: Discussionunclassified

“…Contagens mais elevadas dessas células proporcionam respostas mais efetivas da PT contrariamente à condição da anergia cutânea 44 , que ocorre quando a contagem de linfócitos TCD4+ está em níveis muito baixos 45 , favorecendo o resultado falso negativo 19,31 . Assim, mesmo que o paciente esteja infectado pode não responder adequadamente ao exame.…”

Section: Cad Saúde Pública 2017; 33(8):e00050916unclassified

Infecção latente por tuberculose entre pessoas com HIV/AIDS, fatores associados e progressão para doença ativa em município no Sul do Brasil

et al. 2017

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Resumo: Propôs-se levantar a prevalência de infecção latente por tuberculose (ILTB) entre pessoas vivendo com HIV/AIDS (PVHA), fatores associados e se entre os casos identificados houve progressão para tuberculose ativa. Trata-se de estudo epidemiológico e descritivo. A população foi composta de PVHA, atendidas entre 2003 e 2014 em um centro de referência para HIV/AIDS. Os dados foram coletados com base em prontuários e fichas do Sistema de Informação de Agravos de Notificação (SINAN). Procedeu-se à estatística bivariada, com aplicação do teste qui-quadrado, em que as variáveis com valores de p < 0,2 foram selecionadas para entrar no modelo de regressão múltipla. Foi fixado em todos os testes o erro tipo I em 5% (p < 0,05). No estudo, 690 casos foram analisados, sendo que 66 (9,4%) apresentaram o diagnóstico de ILTB, tendo uma prevalência de 7,5 casos para cada 100 pacientes. Dos 53 (80,3%) casos de ILTB que tiveram o tratamento indicado com isoniazida, apenas 26 (39,4%) concluíram e 10 (15,1%) abandonaram. Observou-se que as variáveis sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situação prisional (OR ajustado = 7,6; IC95%: 2,35-24,9) e contagem de linfócitos mais altos são fatores associados ao diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Verificou-se que 47 (6,7%) dos casos de ILTB progrediram para TB ativa. O diagnóstico e o tratamento de ILTB nas PVHA não foram priorizados, o que contribuiu para o desenvolvimento de doença ativa entre os casos. O trabalho contribuiu para o avanço do conhecimento acerca da ILTB entre PVHA, demonstrando aspectos cruciais no que tange ao manejo de PVHA e ainda a importância da detecção da ILTB e a instituição precoce da isoniazida, visando à melhor qualidade de vida e prognóstico das PVHA.

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Interferon-gamma release assay versus tuberculin skin test for latent tuberculosis infection among HIV patients in Brazil

Abstract: The higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.

Cited by 22 publications

References 27 publications

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Access and adherence to isoniazid preventive therapy and occurrence of active TB in a cohort of people living with HIV: a retrospective cohort study in Sao Paulo, Brazil

Infecção latente por tuberculose entre pessoas com HIV/AIDS, fatores associados e progressão para doença ativa em município no Sul do Brasil

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