Yield of repeat tuberculin skin testing for people living with HIV in Brazil

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone.

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The effectiveness of prevention and early detection of tuberculosis in people living with HIV

10.1101/2020.06.30.179895 ◽

2020 ◽

Author(s):

Mikhail Sinitsyn ◽

Evgeniy Belilovsky ◽

Elena Bogorodskaya ◽

Sergey Borisov ◽

Dmitry Kudlay ◽

...

Keyword(s):

Early Detection ◽

Skin Testing ◽

Latent Tuberculosis ◽

Preventive Therapy ◽

Tuberculosis Infection ◽

People Living With Hiv ◽

Notification Rate ◽

Hiv Patients ◽

Living With Hiv ◽

Full Design

AbstractBackgroundThe difficult epidemic situation caused by TB/HIV co-infection and, accordingly, the need to strengthen measures for the prevention of tuberculosis among HIV patients, identified the need to create a model of collaborating tuberculosis management facilities and AIDS centers.Study purposeanalysis of the effectiveness of measures used in Moscow to prevent the spread of HIV/tuberculosis co-infection based on the developed new algorithm.Materials and methodsThe design of the study – a full-design retrospective cohort study of all HIV patients in tuberculosis preventive care and early detection unit for HIV patients (PCED TB Unit), which was organized in 2014 as a subdivision of Moscow TB Center on the premises of the Moscow AIDS Center. The study was conducted from 2014 to 2017. 22,190 HIV-infected patients were examined. In order to detect tuberculosis infection, all HIV patients were referred for skin testing with preparation Diaskintest, which represents recombinant proteins CFP10-ESAT6 and persons with a positive and doubtful reaction were examined for the diagnosis of tuberculosis and latent tuberculosis infection (LTBI). Preventive therapy (PT) was prescribed to patients with LTBI, which was also received by those with CD4+count ≤350 cells/mm3, regardless of the results of a skin test.ResultsOver a period of 4 years, Diaskintest was performed in 19,777 people. Positive results were in 857 patients (4.3%) [95% CI 4.1-4.6]. 131 patients were diagnosed with tuberculosis, the rest - with LTBI. The effectiveness of PT was estimated by the number of TB cases detected among HIV patients who completed PT (1757) and those who did not receive it (5990). The notification rate of TB in the first group was 228 [95%CI 65-582] per 100,000 patients, in the second 1486 [95%CI 1195–1825], which is 6,5 times higher. To assess the effectiveness of early detection of TB, the proportion of severity forms of pulmonary TB diagnosed in 87 patients at the PCED TB Unit using a new algorithm in 2016-2017 were compared with 411patients detected in different medical organizations of Moscow using conventional methods. The proportion of disseminated TB was lower in the first group (23.0% versus 44.5%) (p<0.01).ConclusionThe study showed that the integration of the two services allows increases the accessibility of TB care and makes a significant contribution to improving the effectiveness of measures to prevent the TB spread among HIV patients. It supports the necessity of treating LTBI detected using the Diaskintest to prevent TB in HIV-infected patients. Significant effects that have been achieved include a reduction in the TB notification rate among HIV patients, improvement of the diagnostic structure of registered TB cases as a result of their timely detection.

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