TY - JOUR
T1 - Risk Assessment of Tuberculosis in Immunocompromised Patients - A TBNET Study
AU - Sester, Martina
AU - van Leth, Frank
AU - Bruchfeld, Judith
AU - Bumbacea, Dragos
AU - Cirillo, Daniela M
AU - Gorek Dilektasli, Asli
AU - Domínguez, José
AU - Duarte, Raquel
AU - Ernst, Martin J.
AU - Oner Eyuboglu, Fusun
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 - for the TBNET
PY - 2014/10/10
Y1 - 2014/10/10
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 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.
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 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.
U2 - 10.1164/rccm.201405-0967OC
DO - 10.1164/rccm.201405-0967OC
M3 - Journal article
C2 - 25303140
SN - 1073-449X
VL - 190
SP - 1168
EP - 1176
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 10
ER -