29/2/20

Latent tuberculosis infection screening in persons newly-diagnosed with HIV infection in Italy: A multicentre study promoted by the Italian Society of Infectious and Tropical Diseases

Goletti D, Navarra A, Petruccioli E, Cimaglia C, Compagno M, Cuzzi G, De  Carli G, Fondaco L, Franzetti F, Giannetti A, Gori A, Lapadula G,  Lichtner M, Mastroianni CM, Mazzotta V, Orchi N, Pavone P, Piacentini D,  Pirriatore V, Pontali E, Sarmati L, Spolti A, Tacconelli E, Galli M,  Antinori A, Calcagno A, Girardi E.

Int J Infect Dis. 2020 Mar;92:62-68. doi: 10.1016/j.ijid.2019.12.031., 03/2020.

Background: The  Italian Society of Infectious and Tropical Diseases performed a survey  on the application of guidelines for the management of persons living  with HIV (PLWH), to evaluate current practice and the yield of screening  for latent tuberculosis infection (LTBI) in newly-diagnosed PLWH; in  addition, the offer of preventive therapy to LTBI individuals and the  completion rate were analysed.


Materials and methods: Newly-diagnosed  PLWH in nine centres were evaluated retrospectively (2016/2017) using  binary and multinomial logistic regression to identify factors  associated with LTBI diagnostic screening and QuantiFERON (QFT) results.


Results: Of  801 patients evaluated, 774 were studied after excluding active TB.  LTBI tests were performed in 65.5%. Prescription of an LTBI test was  associated with being foreign-born (odds ratio (OR) 3.19, p < 0.001),  older (for 10-year increments, OR 1.22, p = 0.034), and having a CD4  count <100 cells/mm3 vs ≥500 cells/mm3 (OR 2.30, p = 0.044). LTBI was  diagnosed in 6.5% of 495 patients evaluated by QFT. Positive results  were associated with being foreign-born (relative risk ratio (RRR)  30.82, p < 0.001), older (for 10-year increments, RRR 1.78, p =  0.003), and having a high CD4 count (for 100 cells/mm3 increments, RRR  1.26, p < 0.003). Sixteen LTBI individuals started TB preventive  therapy and eight completed it.


Conclusions: LTBI  screening is inconsistently performed in newly-diagnosed PLWH.  Furthermore, TB preventive therapy is not offered to all LTBI  individuals and compliance is poor.


Keywords: Active TB; CD4 T-cells; HIV; IGRA; LTBI; Latency; Quantiferon; Tuberculosis.