PMID- 25515915 OWN - NLM STAT- MEDLINE DCOM- 20151028 LR - 20211203 IS - 1471-2334 (Electronic) IS - 1471-2334 (Linking) VI - 14 DP - 2014 Dec 17 TI - HIV patients with latent tuberculosis living in a low-endemic country do not develop active disease during a 2 year follow-up; a Norwegian prospective multicenter study. PG - 667 LID - 10.1186/s12879-014-0667-0 [doi] LID - 667 AB - BACKGROUND: Interferon-gamma release assays (IGRA) serve as immunodiagnostics of tuberculosis (TB) infection to identify individuals with latent TB infection (LTBI) eligible for preventive anti-TB therapy. In this longitudinal study of HIV-infected LTBI patients we have observed for possible progression to active TB as well as evaluated repeated IGRA testing in a TB low-endemic setting. METHODS: QuantiFERON TB-Gold In-tube(R) assay (QFT), TB-SPOT.TB(R) (TSPOT) and tuberculin skin test (TST) were performed on 298 HIV-patients recruited from seven out-patient clinics in Norway. Patients with active TB, LTBI and negative IGRA were followed with repeat QFTs and clinical evaluation over a period of 24 months. RESULTS: Seven HIV-patients (median CD4 count 270; IQR 50-340) were diagnosed with active TB at inclusion, all IGRA positive. Sixty-four (21%) HIV-patients (median CD4 count 471; IQR 342-638) were diagnosed with LTBI and of these 39 (61%) received TB preventive treatment. Neither treated nor untreated HIV-infected LTBI patients developed active TB during the 24 months. At baseline, the median interferon-gamma (INF-gamma) level measured by QFT was 3.48 IU/ml (IQR 0.94-8.91 IU/ml) for treated LTBI compared to 1.13 IU/ml (IQR 0.47-4.25 IU/ml) for untreated LTBI patients (p = 0.029). The QFT reversion rates were 75% for active TB, 23% for treated LTBI and 44% for untreated LTBI, whereas the conversion rate for the non-TB group was 7% despite no new TB exposure. There was no significant difference in the trend of INF-gamma levels over time between treated and untreated LTBI patients. CONCLUSION: The prevalence of LTBI is high among HIV-patients, but the risk of developing active TB seems to be low in patients with high CD4 counts in this TB low-endemic setting. In several patients, especially with baseline IFN-gamma levels close to cut-offs, the QFT tests reverted to negative independent of preventive anti-TB treatment indicating possibly false positive tests. This highlights the importance of defining reliable cut-offs for immunodiagnostic tests and deferring preventive therapy in selected patients. Randomized studies with longer follow-up time are needed to identify HIV-patients that would benefit from LTBI treatment in a TB low-endemic setting. FAU - Pullar, Nadine Durema AU - Pullar ND AD - Department of Internal Medicine, Section for Infectious Diseases, University Hospital of Northern Norway, N-9038, Tromso, Norway. nadine.pullar@gmail.com. AD - Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, N-9037, Tromso, Norway. nadine.pullar@gmail.com. FAU - Steinum, Harald AU - Steinum H AD - Department of Infectious Diseases, Trondheim University Hospital, N-7004, Trondheim, Norway. harald.steinum@stolav.no. FAU - Bruun, Johan Nikolai AU - Bruun JN AD - Department of Internal Medicine, Section for Infectious Diseases, University Hospital of Northern Norway, N-9038, Tromso, Norway. johan.nikolai.bruun@unn.no. AD - Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, N-9037, Tromso, Norway. johan.nikolai.bruun@unn.no. FAU - Dyrhol-Riise, Anne Ma AU - Dyrhol-Riise AM AD - Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, N-5021, Bergen, Norway. a.m.d.riise@medisin.uio.no. AD - Present address: Department of Infectious Diseases, Oslo University Hospital (Ulleval), pb 4956 Nydalen, 0424, Oslo, Norway. a.m.d.riise@medisin.uio.no. AD - Institute of Clinical Medicine, University of Oslo, 0316, Oslo, Norway. a.m.d.riise@medisin.uio.no. LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20141217 PL - England TA - BMC Infect Dis JT - BMC infectious diseases JID - 100968551 SB - IM MH - Adult MH - CD4 Lymphocyte Count MH - Coinfection/immunology MH - Disease Progression MH - Endemic Diseases MH - Ethnicity MH - Female MH - Follow-Up Studies MH - HIV Infections/epidemiology/*immunology MH - Humans MH - Interferon-gamma Release Tests MH - Latent Tuberculosis/epidemiology/*immunology MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Norway/epidemiology MH - Prevalence MH - Prospective Studies MH - Tuberculin Test MH - Tuberculosis, Pulmonary/*diagnosis/epidemiology/immunology PMC - PMC4273430 EDAT- 2014/12/18 06:00 MHDA- 2015/10/29 06:00 PMCR- 2014/12/17 CRDT- 2014/12/18 06:00 PHST- 2014/11/17 00:00 [received] PHST- 2014/11/26 00:00 [accepted] PHST- 2014/12/18 06:00 [entrez] PHST- 2014/12/18 06:00 [pubmed] PHST- 2015/10/29 06:00 [medline] PHST- 2014/12/17 00:00 [pmc-release] AID - s12879-014-0667-0 [pii] AID - 667 [pii] AID - 10.1186/s12879-014-0667-0 [doi] PST - epublish SO - BMC Infect Dis. 2014 Dec 17;14:667. doi: 10.1186/s12879-014-0667-0.