RT Journal Article
SR Electronic
T1 Comparison of screening strategies to improve the diagnosis of latent tuberculosis infection in the HIV-positive population: a cohort study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e000762
DO 10.1136/bmjopen-2011-000762
VO 2
IS 2
A1 Katrina M Pollock
A1 Herman Tam
A1 Lisa Grass
A1 Sharleen Bowes
A1 Graham S Cooke
A1 Manish Pareek
A1 Damien Montamat-Sicotte
A1 Moses Kapembwa
A1 Graham P Taylor
A1 Ajit Lalvani
YR 2012
UL http://bmjopen.bmj.com/content/2/2/e000762.abstract
AB Background HIV is the most important risk factor for progression of latent tuberculosis infection (LTBI) to active tuberculosis (TB). Detection and treatment of LTBI is necessary to reduce the increasing burden of TB in the UK, but a unified LTBI screening approach has not been adopted.Objective To compare the effectiveness of a TB risk-focused approach to LTBI screening in the HIV-positive population against current UK National Institute for Health and Clinical Excellence (NICE) guidance.Design Prospective cohort study.Setting Two urban HIV treatment centres in London, UK.Participants 114 HIV-infected individuals with defined TB risk factors were enrolled prospectively as part of ongoing studies into HIV and TB co-infection.Outcome measures The yield and case detection rate of LTBI cases within the research study were compared with those generated by the NICE criteria.Results 17/114 (14.9%, 95% CI 8.3 to 21.5) had evidence of LTBI. Limiting screening to those meeting NICE criteria for the general population (n=43) would have detected just over half of these, 9/43 (20.9%, 95% CI 8.3 to 33.5) and those meeting criteria for HIV co-infection (n=74) would only have captured 8/74(10.8%, 95% CI 3.6 to 18.1) cases. The case detection rates from the study and NICE approaches were not significantly different. LTBI was associated with the presence of multiple TB risk factors (p=0.002).Conclusion Adoption of a TB risk-focused screening algorithm that does not use CD4 count stratification could prevent more cases of TB reactivation, without changing the case detection rate. These findings should be used to inform a large-scale study to create unified guidelines.