Ntshiqa Thobani, Velen Kavindhran, Ginindza Sibuse, Nhlangulela Lindiwe, Charalambous Salome, Hawn Thomas R, Churchyard Gavin, Boom W Henry, Chihota Violet, Wallis Robert
The Aurum Institute, Johannesburg, South Africa.
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2025 May 9;20(5):e0318819. doi: 10.1371/journal.pone.0318819. eCollection 2025.
A small proportion of goldminers in South Africa resist tuberculin skin test (TST)/interferon-gamma release assay (IGRA) conversion despite high rates of HIV and prolonged exposure to TB. We conducted a study among HIV-infected goldminers to determine the: i) proportion who resisted TST/IGRA conversion and ii) epidemiological factors associated with resistance to TST/IGRA conversion.
We enrolled HIV-infected goldminers who were on antiretroviral treatment, aged 33-60 years, with ≥15 years' service, no prior or current TB, no silicosis, and with body mass index >18.5 kg/m2. TST/IGRA conversion was assessed at baseline, 6 months, and 12 months using TST and QuantiFERON-TB-Gold-Plus (QFT-Plus). Miners were considered resisters if they had a zero TST response and a negative QFT-Plus at all visits. Logistic regression was used to identify epidemiological factors associated with TST/IGRA conversion resistance.
We enrolled 245 HIV-infected miners with median age of 48 years (interquartile-range [IQR]: 44-52 years) and median CD4 count, 506 cells/ µ L (IQR: 372-677 cells/ µ L). Overall, 98.4% (241) were males and 99.2% (243) were Black/African with a median time of 24 years (IQR: 18-29 years) in the workforce. Of those completing all follow-ups, 24.3% (50/206) resisted TST/IGRA conversion. Miners who had a history of taking isoniazid preventive therapy (IPT) (adjusted odds ratio (aOR) 2.34; 95% confidence interval (CI): 1.14-4.80; p = 0.020) were more likely to resist TST/IGRA conversion. However, those from Mozambique (aOR 0.16; 95% CI: 0.04-0.71; p = 0.016) and those who had a CD4 count ≥500 cells/ µ L (aOR 0.46; 95% CI: 0.23-0.92; p = 0.028) were less likely to resist TST/IGRA conversion.
Similar to previous longitudinal cohort studies, we found a small proportion of HIV-infected goldminers who resisted TST/IGRA conversion. This was positively associated with prior IPT, but negatively associated with lower CD4 count and being from Mozambique. However, mechanisms underlying TST/IGRA conversion resistance are not well understood.
尽管南非金矿工人中艾滋病毒感染率很高且长期接触结核病，但仍有一小部分人结核菌素皮肤试验（TST）/干扰素-γ释放试验（IGRA）不发生转换。我们在感染艾滋病毒的金矿工人中开展了一项研究，以确定：i）TST/IGRA转换抵抗者的比例；ii）与TST/IGRA转换抵抗相关的流行病学因素。
我们纳入了接受抗逆转录病毒治疗、年龄在33至60岁之间、工作年限≥15年、既往和目前均无结核病、无矽肺病且体重指数>18.5kg/m²的感染艾滋病毒的金矿工人。在基线、6个月和12个月时使用TST和QuantiFERON-TB-Gold-Plus（QFT-Plus）评估TST/IGRA转换情况。如果矿工在所有访视中TST反应为零且QFT-Plus为阴性，则被视为转换抵抗者。采用逻辑回归确定与TST/IGRA转换抵抗相关的流行病学因素。
我们纳入了245名感染艾滋病毒的矿工，中位年龄为48岁（四分位间距[IQR]：44至52岁），中位CD4细胞计数为506个/µL（IQR：372至677个/µL）。总体而言，98.4%（241名）为男性，99.2%（243名）为黑人/非洲人，在职中位时间为24年（IQR：18至29年）。在完成所有随访的人中，24.3%（50/206）抵抗TST/IGRA转换。有服用异烟肼预防性治疗（IPT）史的矿工（调整优势比[aOR]2.34；95%置信区间[CI]：1.14至4.80；p=0.020）更有可能抵抗TST/IGRA转换。然而，来自莫桑比克的矿工（aOR 0.16；95%CI：0.04至0.71；p=0.016）以及CD4细胞计数≥500个/µL的矿工（aOR 0.46；95%CI：0.23至0.92；p=0.028）抵抗TST/IGRA转换的可能性较小。
与之前的纵向队列研究相似，我们发现一小部分感染艾滋病毒的金矿工人抵抗TST/IGRA转换。这与既往IPT呈正相关，但与较低的CD4细胞计数以及来自莫桑比克呈负相关。然而，TST/IGRA转换抵抗的潜在机制尚不清楚。
