Arriaga María B, Amorim Gustavo, Figueiredo Marina C, Staats Cody, Kritski Afrânio L, Cordeiro-Santos Marcelo, Rolla Valeria C, Andrade Bruno B, Sterling Timothy R
Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Infect Dis. 2025 Feb 4;231(1):103-108. doi: 10.1093/infdis/jiae285.
Diagnosis of Mycobacterium tuberculosis infection in close contacts is critical for tuberculosis control. Smoking is a risk factor for M. tuberculosis infection and tuberculosis disease but its effect on longitudinal interferon γ release assay (IGRA) results remains unknown. We conducted a multisite prospective study in Brazil between 2015 and 2019, among close contacts of adults with culture-confirmed pulmonary tuberculosis. IGRA was performed at baseline, at month 6 if results were negative at baseline, and at months 24-30 after enrollment. IGRA results were categorized as IGRA positive (maintained from baseline to the last visit), IGRA conversion (from negative to positive at any time), IGRA reversion (from positive to negative at any time), and IGRA negative (maintained from baseline to the last visit). Associations between IGRA results and smoking status at baseline (current/former vs never) in contacts were evaluated using propensity score-adjusted logistic regression models. Estimated propensity score was used as a covariate in models, which regressed the outcome (IGRA positive, IGRA conversion, IGRA reversion) on smoking status. Of 430 close contacts, 89 (21%) were IGRA positive, 30 (7%) were converters, 30 (7%) were reverters and 22 were indeterminate. Smoking frequency was 26 (29%) among IGRA-positive contacts, 7 (23%) in converters, and 3 (10%) in reverters. Smoking in contacts was associated with lower odds of IGRA reversion (adjusted odds ratio, 0.16 [95% confidence interval, .03-.70]). We did not detect associations between smoking and IGRA positive or IGRA conversion. Our findings highlight the importance of smoking on longitudinal IGRA results. This has implications for clinical care and clinical trials in which IGRA status is monitored or used as an outcome.
对结核病密切接触者进行结核分枝杆菌感染诊断对结核病控制至关重要。吸烟是结核分枝杆菌感染和结核病的一个危险因素，但其对纵向干扰素γ释放试验（IGRA）结果的影响尚不清楚。2015年至2019年期间，我们在巴西对成年肺结核确诊患者的密切接触者开展了一项多中心前瞻性研究。在基线时、如果基线结果为阴性则在第6个月、以及入组后第24 - 30个月进行IGRA检测。IGRA结果分为IGRA阳性（从基线到最后一次随访保持阳性）、IGRA转换（在任何时间从阴性转为阳性）、IGRA逆转（在任何时间从阳性转为阴性）和IGRA阴性（从基线到最后一次随访保持阴性）。使用倾向评分调整的逻辑回归模型评估密切接触者中IGRA结果与基线吸烟状态（当前/既往吸烟者与从不吸烟者）之间的关联。估计倾向评分在模型中用作协变量，该模型根据吸烟状态对结局（IGRA阳性、IGRA转换、IGRA逆转）进行回归分析。在430名密切接触者中，89名（21%）IGRA阳性，30名（7%）为转换者，30名（7%）为逆转者，22名结果不确定。IGRA阳性接触者中的吸烟频率为26名（29%），转换者中为7名（23%），逆转者中为3名（10%）。密切接触者吸烟与IGRA逆转几率较低相关（调整后的优势比，0.16 [95%置信区间，0.03 - 0.70]）。我们未检测到吸烟与IGRA阳性或IGRA转换之间的关联。我们的研究结果突出了吸烟对纵向IGRA结果的重要性。这对监测IGRA状态或用作结局的临床护理和临床试验具有启示意义。
