Strategy to better select HIV-infected individuals for latent TB treatment in BCG-vaccinated population

Chin-Hui Yang; Pei-Chun Chan; Say-Tsung Liao; Shu-Hsing Cheng; Wing-Wai Wong; Li-Min Huang; Po-Ren Hsueh; Hung-Yi Chiou

doi:10.1371/journal.pone.0073069

Strategy to better select HIV-infected individuals for latent TB treatment in BCG-vaccinated population

PLoS One. 2013 Aug 27;8(8):e73069. doi: 10.1371/journal.pone.0073069. eCollection 2013.

Authors

Chin-Hui Yang¹, Pei-Chun Chan, Say-Tsung Liao, Shu-Hsing Cheng, Wing-Wai Wong, Li-Min Huang, Po-Ren Hsueh, Hung-Yi Chiou

Affiliation

¹ Centers for Disease Control, Department of Health, Taipei, Taiwan ; Ph.D. Program, School of Public Health, Taipei Medical University, Taipei, Taiwan ; Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.

Abstract

Objective: To evaluate the T-SPOT.TB interferon-γ releasing assay and the tuberculin skin test (TST), for the diagnosis of latent tuberculosis infection(LTBI) and the development of subsequent active tuberculosis, in BCG-vaccinated HIV-infected individuals.

Methods: HIV-infected individuals without clinical suspicion of active TB or a past history of TB were enrolled from 1 January 2008 to 30 November 2010. Both T-SPOT.TB test and TST were offered to the participants whom were followed up prospectively until April 30, 2012 for development of TB.

Results: Among the 909 participants, 25% had positive TST reactions with cut-off point of 5 mm and 15% had positive T-SPOT.TB results. After a median follow-up of 2.97 years, there were 5 cases developed culture-confirmed active TB (all had dual positive TST and T-SPOT.TB results), and the incidence was 0.17 per 100 person-years. The relative risks (RRs) for subsequent active TB in HIV-infected individuals with positive TST results, positive T-SPOT.TB results and dual positive results compared with the risk for individuals with negative results were 40.6 (95% CI 2.1-767.9), 73.9 (95% CI 3.9-1397.7) and 226.5 (95% CI 12.0-4284), respectively. The number needed to treat to prevent one subsequent TB case among patients with a positive TST, a positive T-SPOT.TB and dual positive results was 35, 22 and 8 respectively.

Conclusions: Adopting positive results of the TST and T-SPOT.TB to screen LTBI among BCG-vaccinated HIV-infected individuals might be feasible. Number needed to treat for isoniazid preventive therapy could be reduced significantly by using dual positive strategy.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Antitubercular Agents / administration & dosage*
Female
Follow-Up Studies
HIV Infections*
Humans
Isoniazid / administration & dosage*
Latent Tuberculosis / diagnosis
Latent Tuberculosis / drug therapy*
Male
Middle Aged
Mycobacterium bovis*
Tuberculin Test

Substances

Antitubercular Agents
Isoniazid

Grants and funding

This study was supported by the Centers for Disease Control, Taiwan (grant DOH97-DC-1502), to which interim progress reports were submitted. The funding body had no role in the study design, data analysis, data interpretation or writing of the report but was involved in data collection.