Tuberculosis Skin Testing Among HIV-Infected Pregnant Women in Miami, 1995 to 1996

Schulte, Joann; Bryan, Patricia; Dodds, Sally; Potter, Monell; Onorato, Ida M.; OʼSullivan, Mary J.

doi:10.1038/sj.jp.7210617

Cited by 12 publications

(16 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More than 10% of women did not return for their TST result, especially in the postpartum group. This is similar to what other studies have observed [10], [33] and highlights one of the weaknesses of TST.…”

Section: Discussionsupporting

confidence: 91%

Pregnancy Differentially Impacts Performance of Latent Tuberculosis Diagnostics in a High-Burden Setting

et al. 2014

View full text Add to dashboard Cite

BackgroundTargeted screening for latent TB infection (LTBI) in vulnerable populations is a recommended TB control strategy. Pregnant women are at high risk for developing TB and likely to access healthcare, making pregnancy an important screening opportunity in developing countries. The sensitivity of the widely-used tuberculin skin test (TST), however, may be reduced during pregnancy.MethodsWe performed a cross-sectional study comparing the TST with the QuantiFERON Gold In-tube (QGIT) in 401 HIV-negative women presenting antepartum (n = 154), at delivery (n = 148), or postpartum (n = 99) to a government hospital in Pune, India. A subset of 60 women enrolled during pregnancy was followed longitudinally and received both tests at all three stages of pregnancy.ResultsThe QGIT returned significantly more positive results than the TST. Of the 401 women in the cross-sectional study, 150 (37%) had a positive QGIT, compared to 59 (14%) for the TST (p<0.005). Forty-nine (12%) did not have their TST read. Of 356 who had both results available, 46 (13%) were concordant positive, 91 (25%) were discordant (12 (3%) TST+/QGIT-; 79 (22%) TST−/QGIT+), and 206 (57%) concordant negative. Comparison by stage of pregnancy revealed that QGIT percent positivity remained stable between antepartum and delivery, unlike TST results (QGIT 31–32% vs TST 11–17%). Median IFN-γ concentration was lower at delivery than in antepartum or postpartum (1.66 vs 2.65 vs 8.99 IU/mL, p = 0.001). During postpartum, both tests had significantly increased positives (QGIT 31% vs 32% vs 52%, p = 0.01; TST 17% vs 11% vs 25%, p<0.005). The same trends were observed in the longitudinal subset.ConclusionsTiming and choice of LTBI test during pregnancy impact results. QGIT was more stable and more closely approximated the LTBI prevalence in India. But pregnancy stage clearly affects both tests, raising important questions about how the complex immune changes brought on by pregnancy may impact LTBI screening.

show abstract

Section: Discussionsupporting

confidence: 91%

Pregnancy Differentially Impacts Performance of Latent Tuberculosis Diagnostics in a High-Burden Setting

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Countries that already perform targeted screening or are considering integrating LTBI screening into antenatal programs may benefit from using the IGRA in addition to or instead of TST. Although the TST is less expensive, it presents operational challenges, which result in unread TST results in 15% or more of pregnant and postpartum women (27).…”

Section: Discussionmentioning

confidence: 99%

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Mathad

Bhosale

Balasubramanian

et al. 2016

Am J Respir Crit Care Med

View full text Add to dashboard Cite

Rationale: Pregnant women with latent tuberculosis infection (LTBI) are at high risk for development of TB, especially if infected with HIV.Objectives: To assess the performance of LTBI tests in pregnant and postpartum women infected with HIV, investigate the immunology behind discordance in pregnancy, and explore the implications for the development of postpartum TB.Methods: We screened pregnant women in their second/third trimester and at delivery for LTBI using the tuberculin skin test (TST) and IFN-g release assay (IGRA) (QuantiFERON Gold). A subset of antepartum women had longitudinal testing, with repeat testing at delivery and postpartum and additional cytokines measured from the IGRA supernatant. The kappa statistic and Wilcoxon rank sum test were used to determine agreement and comparison of cytokine concentrations, respectively.Measurements and Main Results: Of 252 enrolled, 71 (28%) women had a positive IGRA but only 27 (10%) had a positive TST (P , 0.005). There was 75% agreement (kappa, 0.25). When stratified by pregnancy versus delivery, 20% had IGRA 1 /TST 2 discordance at each time point. A positive IGRA was associated with known TB contact (odds ratio, 3.6; confidence interval, 1.2-11.1; P = 0.02). Compared with IGRA 1 /TST 1 , women with IGRA 1 /TST 2 discordance had significantly less IFN-g (1.85 vs. 3.48 IU/ml; P = 0.02) and IL-2 (46.17 vs. 84.03 pg/ml; P = 0.01). Five developed postpartum TB, of which three had IGRA 1 /TST 2 discordance during pregnancy.Conclusions: Choice of LTBI test in pregnant women infected with HIV affects results. Pregnant women with IGRA 1 /TST 2 discordance had less IFN-g and IL-2 than those with concordant-positive results and may represent an especially high-risk subset for the development of active TB postpartum.

show abstract

“…Homelessness, and living or working in a collective group or institution, were associated with higher risks of LTBI, 10,13,18,19 Proximity to persons with TB was also important; close contact with a TB case increased the risk of LTBI 10,11,19,21,45 and active TB, 25,29,40 and a study set in a prison demonstrated that closer proximity was associated with increased risk. 25…”

Section: Other Social Risk Factorsmentioning

confidence: 99%

“…Age Greater risk with increasing age: 1 study 19 QFT-GIT-positive participants were significantly younger than QFT-GIT-negative participants: 1 study 11 No association: 11 studies 10,12,13,[16][17][18][21][22][23][24]45 Ethnicity Greater risk for black participants than white participants: 4 studies 15,17,19,23 Greater risk for Asian participants than white participants: 2 studies 13,17 Greater risk for Hispanic participants than white participants: 1 study 15 No association: 2 studies 18,22 Country of birth or residence Greater risk of LTBI in participants who were born abroad: 4 studies 13,21,23,24 Greater risk of LTBI in participants born in Africa: 3 studies 23,24,26 Greater risk for participants who were born or long-term residents in countries with high TB incidence: 7 studies [10][11][12]17,18,22,45 Risk of TB decreased with time since migration: 1 study 45 No association with visiting a TB-endemic country: 1 study 45…”

Section: Sociodemographic Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence

Winter

et al. 2018

int j tuberc lung dis

View full text Add to dashboard Cite

In countries with low tuberculosis (TB) incidence, TB is concentrated in vulnerable populations, including people living with the human immunodeficiency virus (PLHIV), who have a substantially greater risk of TB than people without HIV. We searched PubMed, EMBASE and Web of Science for studies evaluating the risk factors for latent tuberculous infection (LTBI) or active TB in PLHIV in countries with TB incidence 10 per 100 000 population. Due to the number of risk factors evaluated and heterogeneity in study designs, we present summary data and a narrative synthesis. We included 45 studies: 17 reported data on the risk factors for LTBI and 32 on active TB. Black, Asian or Hispanic ethnicity, birth or long-term residence in a country with high TB incidence, and HIV acquisition via injecting drug use (IDU) or heterosexual sex were strong predictors of both LTBI and active TB. History of contact, a greater degree of immunosuppression at diagnosis or higher viral load increased the TB risk. Early HIV diagnosis to allow timely initiation of antiretroviral therapy is essential for the prevention of TB in PLHIV. Screening and treating PLHIV for LTBI to reduce the risk of progression to active TB disease should also be considered to further reduce the burden of active TB in low TB incidence settings. Research to support the expansion of TB and HIV prevention and treatment globally is essential to eliminate TB in low-incidence settings.

show abstract

Tuberculosis Skin Testing Among HIV-Infected Pregnant Women in Miami, 1995 to 1996

Cited by 12 publications

References 8 publications

Pregnancy Differentially Impacts Performance of Latent Tuberculosis Diagnostics in a High-Burden Setting

Pregnancy Differentially Impacts Performance of Latent Tuberculosis Diagnostics in a High-Burden Setting

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence

Contact Info

Product

Resources

About