TB Modelling Group, TB Centre, Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa.
BMC Med. 2021 Oct 29;19(1):252. doi: 10.1186/s12916-021-02127-w.
Tuberculosis (TB) preventive therapy is recommended for all people living with HIV (PLHIV). Despite the elevated risk of TB amongst PLHIV, most of those eligible for preventive therapy would never develop TB. Tests which can identify individuals at greatest risk of disease would allow more efficient targeting of preventive therapy.
We used mathematical modelling to estimate the potential impact of using a blood transcriptomic biomarker (RISK11) to target preventive therapy amongst PLHIV. We compared universal treatment to RISK11 targeted treatment and explored the effect of repeat screening of the population with RISK11.
Annual RISK11 screening, with preventive therapy provided to those testing positive, could avert 26% (95% CI 13-34) more cases over 10 years compared to one round of universal treatment. For the cost per case averted to be lower than universal treatment, the maximum cost of the RISK11 test was approximately 10% of the cost of preventive therapy. The benefit of RISK11 screening may be greatest amongst PLHIV on ART (compared to ART naïve individuals) due to the increased specificity of the test in this group.
Biomarker targeted preventive therapy may be more effective than universal treatment amongst PLHIV in high incidence settings but would require repeat screening.
结核病（TB）预防治疗被推荐用于所有 HIV 感染者（PLHIV）。尽管 PLHIV 患结核病的风险较高，但大多数符合预防治疗条件的人永远不会患上结核病。能够识别疾病风险最高的个体的测试将允许更有效地针对预防治疗。
我们使用数学模型来估计使用血液转录组生物标志物（RISK11）针对 PLHIV 进行预防治疗的潜在影响。我们将普遍治疗与 RISK11 靶向治疗进行了比较，并探讨了对 RISK11 人群进行重复筛查的效果。
与一轮普遍治疗相比，每年进行 RISK11 筛查，并对检测结果阳性者提供预防治疗，在 10 年内可避免 26%（95%CI13-34）更多的病例。为了使每例病例的成本低于普遍治疗，RISK11 检测的最高成本约为预防治疗成本的 10%。由于该测试在该组中的特异性增加，因此，RISK11 筛查的益处可能在接受 ART 治疗的 PLHIV 中最大（与 ART 初治个体相比）。
在高发病率环境中，生物标志物靶向预防治疗可能比 PLHIV 的普遍治疗更有效，但需要重复筛查。
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