Latent and subclinical tuberculosis in HIV infected patients: a cross-sectional study

HIV and tuberculosis (TB) are commonly associated. Identifying latent and asymptomatic tuberculosis infection in HIV-positive patients is important in preventing death and morbidity associated with active TB.

Methods: Cross-sectional study of one time use of an interferon-gamma release assay (T-SPOT.TB - immunospot) to detect tuberculosis infection in patients in an inner city HIV clinic with a large sub-Saharan population.

Results: 542 patient samples from 520 patients who had disclosed no symptoms of TB were screened.

Median follow-up was 35 months (range 27-69). More than half (55%) originated from countries with medium or high tuberculosis burden and 57% were women.

Antiretroviral therapy was used by 67%; median CD4 count at test was 458 cells/ul. A negative test was found in 452 and an indeterminate results in 40 (7.4%) but neither were associated with a low CD4 count.

A positive test was found in 50 individuals. All patients with positive tests were referred to the TB specialist, 47 (94%) had a chest radiograph and 46 (92%) attended the TB clinic.

Two had culture-positive TB and a third individual with features of active TB was treated. 40 started and 38 completed preventive treatment.

One patient who completed preventive treatment with isoniazid monotherapy subsequently developed isoniazid-resistant pulmonary tuberculosis. No patient with a negative test has developed TB.

Conclusions: The T-SPOT.TB test helped identify active TB in those without symptoms.

There was a high completion rate for preventive treatment in those with a positive test result.

Author: Meaghan M KallKatherine M CoyneNigel J GarrettAileen E BoydAnthony T AshcroftIain ReevesJane AndersonGraham H Bothamley
Credits/Source: BMC Infectious Diseases 2012, 12:107

Published on: 2012-05-04

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