The importance and clinical relevance of baseline LTBI screening in HIV patients
Refereed conference paper presented and published in conference proceedings


摘要Background: HIV patients with latent TB infection (LTBI) could be identified by screening followed by treatment, a strategy recommended to reduce TB reactivation. We hypothesize that baseline screening for HIV patients is an
important measure which would predict subsequent TB disease development.
Methods: Clinical data and LTBI screening (mainly tuberculin sensitivity testing with small proportion of IGRA) results of HIV patients diagnosed between 2002 and mid-2017 in a major HIV clinic in Hong Kong were accessed
retrospectively. Patients aged below 18 at HIV diagnosis or diagnosed with TB within 3 months of HIV diagnosis were excluded. In this cohort, we compared the risk of TB disease development between unscreened patients, those tested with positive and negative results. With TB disease development as an outcome, cox proportional hazard models were performed in SPSS.
Results: Among 3130 eligible patients, 2740 (88%) were male, 2796 (90%) being local residents, and 2450 (78%) were Chinese. A majority (2800, 90%) were aged between 18 and 49 at HIV diagnosis, with 99 (3%) concurrently
diagnosed with diabetes mellitus. A total of 723 (23%) patients had not been tested for LTBI, 284 (9%) were positive at the first test, and 2123 (68%) were negative. With 16621 person-years'' (PY) follow-up, 94 had developed TB disease.
The overall TB incidence was 0.57/100PY (95%C.I.=0.45-0.68): 3.04/100PY (95%C.I.=2.21-4.08) for patients never tested for LTBI, 1.43/100PY (95%C.I.=0.94-2.08) for those tested positive, and 0.21/100PY (95%C.I.=0.14-0.30) who tested negative at the first test. Compared to patients never tested for LTBI, those tested (HR=0.09, 95%C.I.=0.06-0.13) were at significantly lower risk of TB disease development. More unscreened patients were non-Chinese (32% vs 18%), non-local residents (23% vs 7%) and younger at HIV diagnosis (median 32 year-old vs 35 year-old), compared to screened patients. Among LTBI tester, patients positive at the first test (HR=12.14, 95%C.I.=6.98-21.13) had a significantly higher risk for TB disease development, despite the implementation of LTBI treatment.
Conclusions: Baseline LTBI screening for all HIV patients is important for overall reduction of TB incidence. With screening, higher risk individuals who tested positive could be further identified for treatment intervention and subsequent monitoring.
著者Wong NS, Leung CC, Chan KCW, Chan WK, Lin AWC, Lee SS
會議名稱22nd International AIDS Conference and TB 2018

上次更新時間 2020-06-03 於 15:32