Screening for tuberculosis infection and effectiveness of preventive treatment among people with HIV in low-incidence settings

Abstract

To determine the yield of screening for latent tuberculosis infection (LTBI) among people living with HIV (PLHIV) in low tuberculosis (TB) incidence countries (<10 TB cases per 100.000 persons), we performed a systematic review and meta-analysis to assess prevalence and predictive factors of LTBI, rate of TB progression, effect of TB preventive treatment (TPT), and numbers needed to screen. Pubmed and Cochrane Library were searched for studies reporting primary data, excluding studies on active or pediatric TB. We extracted LTBI cases, odds ratios, and TB incidences; pooled estimates using a random-effects model; and used the Newcastle-Ottawa scale for bias. In 51 studies with 65.930 PLHIV, 12% (95% CI 10–14) had a positive LTBI test, which was strongly associated with origin from a TB-endemic country (OR 4.7) and exposure to TB (OR 2.9). Without TPT (10,629 PLHIV), TB incidence was 28/1000 person years (PY; 95% CI 12–45) for LTBI-test positive versus 4/1000 PY (95% CI 0–7) for LTBI-test negative individuals. Among 625 PLHIV (1644 PY) receiving TPT, 15 developed TB (6/1000 PY). An estimated 20 LTBI-positive individuals would need TPT to prevent one case of TB, and numbers needed to screen to detect LTBI or prevent active TB varied according to a priori risk of LTBI. The relatively high prevalence of LTBI among PLHIV and the strong correlation with origin from a TB-endemic country support risk-stratified LTBI screening strategies for PLHIV in low-incidence countries and treating those who test positive.

Screening for Latent Tuberculosis Infection in People Living with HIV: TUBHIVIT Project, a Multicenter Italian Study

“…A reasonable compromise is the regular monitoring of hepatitis markers during therapy to promptly suspend therapy, if necessary. PLHIV have a higher prevalence of LTBI, and data in the literature demonstrate that chemoprophylaxis reduces TB incidence in this group [3]. Additionally, Tecla M. Temu et al found heightened levels of pro-and anti-inflammatory cytokines among PLHIV with LTBI in a study comprising four groups of PLHIV with LTBI and without LTBI and HIV-uninfected individuals with and without LTBI [22].…”

“…Various studies have reported that HIV infection might lead to a 10-110 times higher risk of LTBI reactivation [2]. A recent metanalysis regarding screening for TB infection in PLHIV showed that preventive treatment significantly reduced the incidence of TB in this group [3]. The pooled incidence rate in the preventive treatment group was 6 cases per 1000 person-years, while the pooled incidence rate in the non-preventive treatment group was 65 cases per 1000 person-years [3].…”

“…A recent metanalysis regarding screening for TB infection in PLHIV showed that preventive treatment significantly reduced the incidence of TB in this group [3]. The pooled incidence rate in the preventive treatment group was 6 cases per 1000 person-years, while the pooled incidence rate in the non-preventive treatment group was 65 cases per 1000 person-years [3]. Several screening methods can be used in PLHIV, including symptom-based screening, c-reactive protein, tuberculin skin testing (TST), interferon-gamma release assays (IGRAs), and chest X-rays.…”