title: Latent Tuberculosis Infection Screening and 2-Year Outcome in Antiretroviral-Naive HIV-Infected Patients in a Low-Prevalence Country.
abstract: BACKGROUND
  Diagnosis and treatment of latent tuberculous infection decrease the incidence of tuberculosis (TB) in HIV-infected patients.
  
  
  OBJECTIVE
  To evaluate the diagnostic yield of two IFN-γ release assays and tuberculin skin testing for the screening of latent infection in HIV-infected patients.
  
  
  METHODS
  We performed a prospective study in 29 referral centers for HIV care in France. Asymptomatic, antiretroviral-naive patients infected with HIV-1 who consented to participate underwent two commercial tests (T-SPOT.TB and QuantiFERON-TB Gold In-Tube ELISA test [QFT]) and skin test at enrollment and were followed up for clinical events during 24 months.
  
  
  RESULTS
  Between March 2009 and 2011, 506 patients were included, of whom 415 performed the three tests. Median age was 38 years (interquartile range, 31-45 yr), with median CD4 cell count of 466/μL (337-615 μL), and HIV viral load of 4.5 log10 copies/ml (3.6-4.9 log10 copies/ml). At least one IFN-γ release assay was positive for 55 (13.5%) patients: QFT (n = 43), T-SPOT.TB (n = 34), both (n = 22). Skin test was positive (>5 mm) in 66 (15.9%) patients, with intertest agreement at 81 to 86%. On multivariate analysis, positive IFN-γ release assay was only correlated with country of birth (8.4% for France vs. 17.9% for high-prevalence countries, P = 0.004). Of the 55 patients with positive IFN-γ release assay, 8 (14.5%) developed active TB, all within 120 days. No other case of active TB was diagnosed. Once active TB was excluded, IFN-γ release assay-based latent infection prevalence was 11.8%.
  
  
  CONCLUSIONS
  Systematic screening for latent TB infection by IFN-γ release assay identifies a population at high risk of active TB over the next months. An extensive diagnostic work-up for active TB must follow positive IFN-γ release assay, before considering treatment of latent infection. Clinical trial registered with www.clinicaltrials.gov (NCT00805272).
authors.affiliation: 1 Université Paris Seine Saint Denis, Service de Médecine Interne, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris (AP-HP), Bondy, France.|2 INSERM, U1135, CIMI-Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourgarit
authors.affiliation: 3 Sorbonne Paris-Cité Universités AP-HP, Hôtel-Dieu, Centre d'Epidémiologie Clinique, Université Paris Descartes-Sorbonne Paris Cité, INSERM U1153, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Baron
authors.affiliation: 4 Médecine Interne, Hôpital Pitié Salpêtrière, AP-HP, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Breton
authors.affiliation: 5 Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: 6 Sorbonne Universités, UPMC Univ Paris 6, Maladies Infectieuses et Tropicales, Hôpital Pitié Salpêtrière, AP-HP Paris, France.|7 Sorbonne Universités, UPMC Université Paris 6, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.affiliation: 8 Department of Infectious Diseases, CHU Hôtel Dieu, Nantes, France.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Allavena
authors.affiliation: 9 Maladies Infectieuses et Tropicales, Hôpital Saint Antoine, AP-HP, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Campa
authors.affiliation: 10 Université Descartes-Sorbonne Paris Cité, INSERM U1153, Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, French Cochrane Centre, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: 11 Université Paris Descartes, Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker Enfants Malades, APHP, IHU Imagine, Paris, France; and.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: 2 INSERM, U1135, CIMI-Paris, France.|7 Sorbonne Universités, UPMC Université Paris 6, Paris, France.|12 Département d'Immunologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Guislaine
authors.initials: G
authors.lastname: Carcelain
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000379:methods*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014374:Tuberculin Test / Q000379:methods*
keywords: HIV; IFN-γ release assay; latent tuberculosis infection; tuberculin skin test; tuberculosis