The impact, effectiveness and outcomes of targeted screening thresholds for programmatic latent tuberculosis infection testing in HIV

White, Helena; Baggaley, Rebecca F.; Patel, Hemu; Stephenson, Iain; Bodimeade, Chris; Wiselka, Martin; Pareeka, Manish

doi:10.1097/qad.0000000000003364

Cited by 6 publications

(8 citation statements)

References 19 publications

(38 reference statements)

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“…However, we found a positive IGRA test association with a non-Italian country of origin, with most of the non-Italy-born screened individuals coming from Africa. Other studies conducted in low-prevalence countries have shown an association between country of origin and positive results during LTBI screening in PLHIV [13][14][15]. In our study, more than 90% of PLHIV diagnosed with LTBI were recommended chemoprophylaxis, 92.8% (26/28) initiated it, and 88.4% (23/26) completed it or were still on treatment at the time of this analysis.…”

Section: Discussionsupporting

confidence: 53%

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

Pipitò,

Ricci,

Maggi

et al. 2024

Preprint

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Background: The coexistence of HIV infection and latent tuberculosis infection (LTBI) presents a significant public health concern due to the increased risk of tuberculosis (TB) reactivation and progression to active disease. The multicenter observational cohort study, TUBHIVIT, conducted in Italy from 2017 to 2023, aimed to assess the prevalence of LTBI among people living with HIV (PLHIV) and their outcomes following LTBI screening and therapy initiation. Methods: We performed a prospective study in 5 referral centers for HIV care in Italy. PLHIV who consented to participate underwent QuantiFERON-TB Gold Plus and clinical, microbiological, and radiological assessments to exclude subclinical tuberculosis, as opportune. PLHIV diagnosed with LTBI that started chemoprophylaxis were followed until the ending of therapy. Results: A total of 1105 PLHIV were screened for LTBI using the QuantiFERON-TB Gold Plus test, revealing a prevalence of 3.4% of positive results (38/1105). Non-Italy-born individuals exhibited a significantly higher likelihood of testing positive. Thirty-one were diagnosed with LTBI, 1 showed active subclinical TB, 6 were lost to follow-up before discriminating between latent and active TB. Among PLHIV diagnosed with LTBI, 83.9% (26/31) started chemoprophylaxis. Most individuals received 6-9 months of isoniazid-based therapy. Of the 26 PLHIV commencing chemoprophylaxis, 18 (69.2%) completed the therapy, while 3 discontinued it and 5 were still on treatment at the time of the analysis. Adverse events were observed in two cases, while in one case the patient refused to continue the treatment.

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Section: Discussionsupporting

confidence: 53%

“…This prevalence is lower compared to others reported in the literature for PLHIV. Meaghan M Kall et [13][14][15][16]. An Italian survey highlighted a prevalence of 6.5% (32/495) [6], although LTBI screening in PLHIV was not uniformly performed in all investigated centers.…”

Section: Discussionmentioning

confidence: 99%

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

Pipitò,

Ricci,

Maggi

et al. 2024

Preprint

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“…However, it should be noted that this result may be overestimated because of the inclusion of those more at risk for TB and by inclusion of countries that used to have a higher TB incidence during the study period compared with now. Our findings suggest that targeted LTBI screening among PWH in low TB-incidence countries could be more efficient and cost-effective than current strategies, as suggested by a recent interventional study [78]. Certain groups among PWH could be prioritized for screening, such as those from TB-endemic countries or with a history of exposure.…”

Section: Discussionmentioning

confidence: 60%

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

van Geuns,

Arts,

de Vries

et al. 2023

Aids

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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.

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“…OPLWH may catch different infections such as tuberculosis, hepatitis, sexually transmitted diseases or other viral infections. In the UK, both The British HIV Association (BHIVA) and National Institute for Health and Care Excellence (NICE) advocate screening for latent TB infection (LTBI) and treating it, especially in highrisk individuals [82][83][84][85]. Hepatitis, in general, is one of the major causes of mortality and morbidity in HIV (risk of liver cirrhosis and liver cancer).…”

Section: Infectionsmentioning

confidence: 99%

HIV and an Ageing Population—What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions

Ahmed,

Abu-Median

et al. 2023

Microorganisms

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The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug–drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.

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The impact, effectiveness and outcomes of targeted screening thresholds for programmatic latent tuberculosis infection testing in HIV

Cited by 6 publications

References 19 publications

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

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

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

HIV and an Ageing Population—What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions

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