Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Abstract

Background: Tuberculosis (TB) is the leading cause of mortality among people living with the Human immunodeficiency virus (PLHIV), and latent TB infection (LTBI) contributes significantly to active TB. Direct diagnostic methods are the most accurate tests for establishing the LTBI burden. However, current interferon-gamma release assay (IGRA) data on LTBI prevalence in the context of near-universal access to antiretroviral therapy (ART) and widespread TB preventive therapy (TPT) implementation are lacking. We estimated the prevalence and determinants of LTBI among PLHIV within a high TB and HIV burden context. Methods: This cross-sectional analysis of a prospectively collected observational study data included adult PLHIV, in whom QuantiFERON-TB Gold Plus assay, an IGRA, was performed. LTBI was defined as a positive or indeterminate IGRA. Participants with TB and those who had used TB preventive therapy in the past were excluded. Regression analysis was performed to identify independent predictors of LTBI. Results Of 121 PLHIV with IGRA results, females were 74.4% (90/121), and the mean age was 38.4 (standard deviation [SD] 10.8) years. Overall, 47.9% (58/121) were classified as LTBI (IGRA positive and indeterminate results were 39.7% [48/121] and 8.3% [10/121], respectively), with mean ages of 38.7 (SD 10.30) vs 38.2 (SD 11.3) years, respectively (p=0.602). Being obese/overweight (body mass index ≥ 25; p=0.046, adjusted odds ratio (aOR) 2.65, 95% confidence interval [CI] 1.02-6.89), alcohol usage (p=0.036, aOR 3.93, 95% CI 1.10-14.13), and ART usage for >3 years (p=0.012, aOR 2.65, 95% CI 1.23-5.69) were independently associated with LTBI. Conclusion: There was a high LTBI prevalence among PLHIV. A longer period of ART and alcohol consumption were independently associated with LTBI. The relationship between obesity/overweight and LTBI may be related to ART and immune reconstitution and requires further investigation. Recommending IGRA to ascertain LTBI status in PLHIV previously unexposed to TPT may be necessary.