Latent Tuberculosis Infection Screening and 2-Year Outcome in Antiretroviral-Naive HIV-Infected Patients in a Low-Prevalence Country

Anne Bourgarit (1) , Gabriel Baron (2, 3) , Guillaume Breton (4) , Pierre Tattevin (5, 6) , Christine Katlama (7, 4) , Clotilde Allavena (8) , Pauline Campa (9) , Philippe Ravaud (10) , Olivier Lortholary (11, 12) , Guislaine Carcelain (1, 4) , Igravih Study Group

1 CIMI - Centre d'Immunologie et de Maladies Infectieuses
2 CEC - Centre d'Epidémiologie Clinique
3 U738 / UMR_S738 - Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques
4 CHU Pitié-Salpêtrière [AP-HP]
5 Service des maladies infectieuses
6 Fonction, structure et inactivation d'ARN bactériens
7 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
8 Service de maladies infectieuses et tropicales [Nantes]
9 CHU Saint-Antoine [AP-HP]
10 CRESS - U1153 - Equipe 5 : METHODS - Méthodes de l’évaluation thérapeutique des maladies chroniques
11 Centre d'infectiologie Necker-Pasteur [CHU Necker]
12 IMAGINE - U1163 - Imagine - Institut des maladies génétiques

Background - Diagnosis and treatment of latent tuberculous infection decrease the incidence of tuberculosis (TB) in HIV-infected patients. Objectives - To evaluate the diagnostic yield of two IFN-γ release assays and tuberculin skin testing for the screening of latent infection in HIV-infected patients. Methods - We performed a prospective study in 29 referral centers for HIV care in France. Asymptomatic, antiretroviral-naive patients infected with HIV-1 who consented to participate underwent two commercial tests (T-SPOT.TB and QuantiFERON-TB Gold In-Tube ELISA test [QFT]) and skin test at enrollment and were followed up for clinical events during 24 months. Results - Between March 2009 and 2011, 506 patients were included, of whom 415 performed the three tests. Median age was 38 years (interquartile range, 31-45 yr), with median CD4 cell count of 466/μL (337-615 μL), and HIV viral load of 4.5 log10 copies/ml (3.6-4.9 log10 copies/ml). At least one IFN-γ release assay was positive for 55 (13.5%) patients: QFT (n = 43), T-SPOT.TB (n = 34), both (n = 22). Skin test was positive (>5 mm) in 66 (15.9%) patients, with intertest agreement at 81 to 86%. On multivariate analysis, positive IFN-γ release assay was only correlated with country of birth (8.4% for France vs. 17.9% for high-prevalence countries, P = 0.004). Of the 55 patients with positive IFN-γ release assay, 8 (14.5%) developed active TB, all within 120 days. No other case of active TB was diagnosed. Once active TB was excluded, IFN-γ release assay-based latent infection prevalence was 11.8%. Conclusions - Systematic screening for latent TB infection by IFN-γ release assay identifies a population at high risk of active TB over the next months. An extensive diagnostic work-up for active TB must follow positive IFN-γ release assay, before considering treatment of latent infection. Clinical trial registered with www.clinicaltrials.gov (NCT00805272).

Mots clés: HIV; IFN-γ release assay; latent tuberculosis infection; tuberculin skin test; tuberculosis

Domaines: Sciences du Vivant [q-bio]

Anne Bourgarit, Gabriel Baron, Guillaume Breton, Pierre Tattevin, Christine Katlama, et al.. Latent Tuberculosis Infection Screening and 2-Year Outcome in Antiretroviral-Naive HIV-Infected Patients in a Low-Prevalence Country. Annals of the American Thoracic Society, 2015, 12 (8), pp.1138-1145. ⟨10.1513/AnnalsATS.201412-600OC⟩. ⟨hal-01187408⟩