title: Strategy to better select HIV-infected individuals for latent TB treatment in BCG-vaccinated population.
abstract: OBJECTIVE
  To evaluate the T-SPOT.TB interferon-γ releasing assay and the tuberculin skin test (TST), for the diagnosis of latent tuberculosis infection(LTBI) and the development of subsequent active tuberculosis, in BCG-vaccinated HIV-infected individuals.
  
  
  METHODS
  HIV-infected individuals without clinical suspicion of active TB or a past history of TB were enrolled from 1 January 2008 to 30 November 2010. Both T-SPOT.TB test and TST were offered to the participants whom were followed up prospectively until April 30, 2012 for development of TB.
  
  
  RESULTS
  Among the 909 participants, 25% had positive TST reactions with cut-off point of 5 mm and 15% had positive T-SPOT.TB results. After a median follow-up of 2.97 years, there were 5 cases developed culture-confirmed active TB (all had dual positive TST and T-SPOT.TB results), and the incidence was 0.17 per 100 person-years. The relative risks (RRs) for subsequent active TB in HIV-infected individuals with positive TST results, positive T-SPOT.TB results and dual positive results compared with the risk for individuals with negative results were 40.6 (95% CI 2.1-767.9), 73.9 (95% CI 3.9-1397.7) and 226.5 (95% CI 12.0-4284), respectively. The number needed to treat to prevent one subsequent TB case among patients with a positive TST, a positive T-SPOT.TB and dual positive results was 35, 22 and 8 respectively.
  
  
  CONCLUSIONS
  Adopting positive results of the TST and T-SPOT.TB to screen LTBI among BCG-vaccinated HIV-infected individuals might be feasible. Number needed to treat for isoniazid preventive therapy could be reduced significantly by using dual positive strategy.
authors.affiliation: Centers for Disease Control, Department of Health, Taipei, Taiwan ; Ph.D. Program, School of Public Health, Taipei Medical University, Taipei, Taiwan ; Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chin-Hui
authors.initials: CH
authors.lastname: Yang
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chan
authors.forename: Say-Tsung
authors.initials: ST
authors.lastname: Liao
authors.forename: Shu-Hsing
authors.initials: SH
authors.lastname: Cheng
authors.forename: Wing-Wai
authors.initials: WW
authors.lastname: Wong
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage*; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis; D014374:Tuberculin Test
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid