TY - JOUR
T1 - Risk assessment of tuberculosis in immunocompromised patients
T2 - A TBNET study
AU - Sester, Martina
AU - van Leth, Frank
AU - Bruchfeld, Judith
AU - Bumbacea, Dragos
AU - Cirillo, Daniela M
AU - Dilektasli, Asli Gorek
AU - Domínguez, José
AU - Duarte, Raquel
AU - Ernst, Martin
AU - Eyuboglu, Fusun Oner
AU - Gerogianni, Irini
AU - Girardi, Enrico
AU - Goletti, Delia
AU - Janssens, Jean-Paul
AU - Julander, Inger
AU - Lange, Berit
AU - Latorre, Irene
AU - Losi, Monica
AU - Markova, Roumiana
AU - Matteelli, Alberto
AU - Milburn, Heather
AU - Ravn, Pernille
AU - Scholman, Theresia
AU - Soccal, Paola M
AU - Straub, Marina
AU - Wagner, Dirk
AU - Wolf, Timo
AU - Yalcin, Aslihan
AU - Lange, Christoph
AU - TBNET
PY - 2014/11/15
Y1 - 2014/11/15
N2 - RATIONALE: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency.OBJECTIVES: This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis.METHODS: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up.MEASUREMENTS AND MAIN RESULTS: Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy.CONCLUSIONS: Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs. Clinical trial registered with www.clinicaltrials.gov (NCT 00707317).
AB - RATIONALE: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency.OBJECTIVES: This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis.METHODS: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up.MEASUREMENTS AND MAIN RESULTS: Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy.CONCLUSIONS: Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs. Clinical trial registered with www.clinicaltrials.gov (NCT 00707317).
KW - Adult
KW - Aged
KW - Arthritis, Rheumatoid
KW - Cohort Studies
KW - Cross-Sectional Studies
KW - Female
KW - HIV Infections
KW - Humans
KW - Immunocompromised Host
KW - Interferon-gamma Release Tests
KW - Kidney Failure, Chronic
KW - Latent Tuberculosis
KW - Male
KW - Middle Aged
KW - Organ Transplantation
KW - Risk Assessment
KW - Stem Cell Transplantation
KW - Tuberculin Test
U2 - 10.1164/rccm.201405-0967OC
DO - 10.1164/rccm.201405-0967OC
M3 - Journal article
C2 - 25303140
VL - 190
SP - 1168
EP - 1176
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 10
ER -