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 Citations (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.

Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume190
Issue number10
Pages (from-to)1168-1176
ISSN1073-449X
DOIs
Publication statusPublished - 10 Oct 2014

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