Sun Hsin-Yun, Hsueh Po-Ren, Liu Wen-Chun, Su Yi-Ching, Chang Sui-Yuan, Hung Chien-Ching, Chang Shan-Chwen
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
PLoS One. 2015 May 4;10(5):e0125260. doi: 10.1371/journal.pone.0125260. eCollection 2015.
Interferon-gamma release assays (IGRAs) have been used to identify individuals at risk for developing active tuberculosis (TB). However, data regarding the risk of TB development in HIV-infected patients testing positive for IGRAs remain sparse in the era of combination antiretroviral therapy.
Between 2011 and 2013, 608 HIV-infected patients without active TB undergoing T-Spot.TB testing were enrolled in this prospective observational study at a university hospital designated for HIV care in Taiwan with a declining TB incidence from 72 per 100,000 population in 2005 to 53 per 100,000 population in 2012. All of the subjects were followed until September 30, 2014. The national TB registry was accessed to identify any TB cases among those lost to follow-up.
T-Spot.TB tested negative in 534 patients (87.8%), positive in 64 patients (10.5%), and indeterminate in 10 patients (1.6%). In multivariate analysis, positive T-Spot.TB was significantly associated with older age (adjusted odds ratio [AOR], 1.172 per 10-year increase; 95% confidence interval [CI], 1.022-1.344, P=0.023), past history of TB (AOR, 13.412; 95% CI, 6.106-29.460, P<0.001), and higher CD4 counts at enrollment (AOR, per 50-cell/μl increase, 1.062; 95% CI, 1.017-1.109, P=0.007). Of the 64 patients testing positive for T-Spot.TB, none received isoniazid preventive therapy and all but 5 received combination antiretroviral therapy at the end of follow-up with the latest CD4 count and plasma HIV RNA load being 592.8 cells/μL and 1.85 log10 copies/mL, respectively. One patient (1.6%) developed active TB after 167 person-years of follow-up (PYFU), resulting in an incidence rate of 0.599 per 100 PFYU. None of the 534 patients testing negative for T-Spot.TB developed TB after 1380 PYFU, nor did the 24 patients with old TB and positive T-Spot.TB tests develop TB after 62.33 PYFU.
The risk of developing active TB in HIV-infected patients with positive T-Spot.TB receiving combination antiretroviral therapy is low in Taiwan where the national TB program has led to a sustained decrease in TB incidence.
γ-干扰素释放试验（IGRAs）已被用于识别有发生活动性结核病（TB）风险的个体。然而，在联合抗逆转录病毒治疗时代，关于IGRAs检测呈阳性的HIV感染患者发生TB的风险的数据仍然稀少。
2011年至2013年期间，608例无活动性TB的HIV感染患者在台湾一家指定的HIV治疗大学医院接受了T-Spot.TB检测，该医院所在地区的TB发病率从2005年的每10万人72例下降至2012年的每10万人53例。所有受试者均随访至2014年9月30日。通过国家TB登记系统确定失访患者中的任何TB病例。
T-Spot.TB检测结果为阴性的患者有534例（87.8%），阳性的有64例（10.5%），不确定的有10例（1.6%）。在多变量分析中，T-Spot.TB阳性与年龄较大（调整后的优势比[AOR]，每增加10岁为1.172；95%置信区间[CI]，1.022 - 1.344，P = 0.023）、既往TB病史（AOR，13.412；95%CI，6.106 - 29.460，P < 0.001）以及入组时较高的CD4细胞计数（AOR，每增加50个细胞/μl为1.062；95%CI，1.017 - 1.109，P = 0.007）显著相关。在64例T-Spot.TB检测呈阳性的患者中，无人接受异烟肼预防性治疗，除5例患者外，所有患者在随访结束时均接受了联合抗逆转录病毒治疗，最新的CD4细胞计数和血浆HIV RNA载量分别为592.8个细胞/μL和1.85 log10拷贝/mL。1例患者（1.6%）在167人年的随访（PYFU）后发生了活动性TB，发病率为每100 PYFU 0.599例。534例T-Spot.TB检测呈阴性的患者在1380 PYFU后均未发生TB，24例有陈旧性TB且T-Spot.TB检测呈阳性的患者在62.33 PYFU后也未发生TB。
在台湾，由于国家TB防治计划使TB发病率持续下降，接受联合抗逆转录病毒治疗且T-Spot.TB检测呈阳性的HIV感染患者发生活动性TB的风险较低。
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