Risk Assessment of Tuberculosis in Immunocompromised Patients - A TBNET Study

Martina Sester, Frank van Leth, Judith Bruchfeld, Dragos Bumbacea, Daniela M Cirillo, Asli Gorek Dilektasli, José Domínguez, Raquel Duarte, Martin J. Ernst, Fusun Oner Eyuboglu, Irini Gerogianni, Enrico Girardi, Delia Goletti, Jean-Paul Janssens, Inger Julander, Berit Lange, Irene Latorre, Monica Losi, Roumiana Markova, Alberto MatteelliHeather Milburn, Pernille Ravn, Theresia Scholman, Paola M Soccal, Marina Straub, Dirk Wagner, Timo Wolf, Aslihan Yalcin, Christoph Lange, for the TBNET*

191 Citationer (Scopus)

Abstract

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 controls were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA) and T-SPOT.TB test (ELISPOT) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up. Main results: Frequencies of positive test-results varied from 8.7-15.9% in HIV-infection (n=768), 25.3-30.6% in chronic renal failure (n=270), 25.0-37.2% in rheumatoid arthritis (n=199), 9.0-20.0% in solid-organ transplant-recipients (n=197), 0-5.8% in stem-cell transplant-recipients (n=103), and 11.2-15.2% in immunocompetent controls (n=211). Eleven patients (10 with HIV-infection and one solid-organ transplant-recipient) developed tuberculosis during a median follow-up of 1.8 (IQR 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/100 person-years) than with a positive ELISA (1.31 cases/100 person-years) or ELISPOT-result (1.78 cases/100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy. Conclusions: Among immunocompromised patients evaluated in this study, progression towards tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs Clinical trial registration information available at www.clinicaltrials.gov, ID NCT00707317.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Respiratory and Critical Care Medicine
Vol/bind190
Udgave nummer10
Sider (fra-til)1168-1176
ISSN1073-449X
DOI
StatusUdgivet - 10 okt. 2014

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