Latent and subclinical tuberculosis in HIV infected patients: a cross-sectional study
| Autor: | Katherine M Coyne, Nigel Garrett, Jane Anderson, Graham H. Bothamley, Aileen E. Boyd, Iain Reeves, Meaghan Kall, Anthony Ashcroft |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Tuberculosis Adolescent Urban Population Population HIV Infections Asymptomatic lcsh:Infectious and parasitic diseases Young Adult Latent Tuberculosis Internal medicine Prevalence Medicine Humans lcsh:RC109-216 education Subclinical infection Aged education.field_of_study Latent tuberculosis business.industry Incidence (epidemiology) Isoniazid Middle Aged medicine.disease United Kingdom Infectious Diseases Cross-Sectional Studies Immunology Asymptomatic Diseases Female medicine.symptom business Contact tracing Interferon-gamma Release Tests medicine.drug Research Article |
| Zdroj: | BMC Infectious Diseases, Vol 12, Iss 1, p 107 (2012) BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | Background HIV and tuberculosis (TB) are commonly associated. Identifying latent and asymptomatic tuberculosis infection in HIV-positive patients is important in preventing death and morbidity associated with active TB. Methods Cross-sectional study of one time use of an interferon-gamma release assay (T-SPOT.TB - immunospot) to detect tuberculosis infection in patients in a UK inner city HIV clinic with a large sub-Saharan population. Results 542 patient samples from 520 patients who disclosed their symptoms of TB were tested. Median follow-up was 35 months (range 27-69). More than half (55%) originated from countries with medium or high tuberculosis burden and 57% were women. Antiretroviral therapy was used by 67%; median CD4 count at test was 458 cells/μl. A negative test was found in 452 samples and an indeterminate results in 40 (7.4%) but neither were associated with a low CD4 count. A positive test was found in 10% (50/502) individuals. All patients with positive tests were referred to the TB specialist, 47 (94%) had a chest radiograph and 46 (92%) attended the TB clinic. Two had culture-positive TB and a third individual with features of active TB was treated. 40 started and 38 completed preventive treatment. One patient who completed preventive treatment with isoniazid monotherapy subsequently developed isoniazid-resistant pulmonary tuberculosis. No patient with a negative test has developed TB. Conclusions We found an overall prevalence of latent TB infection of 10% through screening for TB in those with HIV infection and without symptoms, and a further 1% with active disease, a yield greater than typically found in contact tracing. Acceptability of preventive treatment was high with 85% of those with latent TB infection eventually completing their TB chemotherapy regimens. IGRA-based TB screening among HIV-infected individuals was feasible in the clinical setting and assisted with appropriate management (including preventive treatment and therapy for active disease). Follow-up of TB incidence in this group is needed to assess the long-term effects of preventive treatment. |
| Databáze: | OpenAIRE |
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