Below: Kaplan-Meier curve of HIV-infected patients who developed active tuberculosis disease by interferon-gamma release assay (IGRA) status, excluding 31 subjects with indeterminate results (N = 741).
Below: Kaplan-Meier curve to development of active tuberculosis disease by composite risk factor combining high HIV viral load of greater than 100,000 copies per mL, CD4 cell count and interferon-gamma release assay (IGRA)(N = 772).
Below: A multivariable algorithm to predict risk of active tuberculosis in people with HIV infection using a composite risk factor of HIV viral load, CD4 cell count and interferon-gamma release assay (IGRA) result.
Seventeen of 772 participants developed active TB during a median follow-up period of 5.21 years. Baseline CD4 < 350/μL or pVL ≥ 100,000/mL was a predictor of active TB (adjusted HR 4.87, 95% CI 1.49–15.90, P = 0.009). A positive baseline IGRA predicted TB in patients with baseline CD4 ≥ 350/μL and pVL < 100,000/mL (adjusted HR 6.09, 95% CI 1.52–24.40, P = 0.01). Compared with an IGRA-alone strategy, the algorithm improved the sensitivity from 37.5% to 76.5%, the negative predictive value from 98.5% to 99.2%. Compared with an untargeted strategy, the algorithm spared 468 (60.6%) from unnecessary TB preventive treatment. Area under the ROC curve was 0.692 (95% CI: 0.587–0.798) for the study cohort and 0.792 (95% CI: 0.776–0.808) and 0.766 in the 2 validation cohorts.
A validated algorithm incorporating the baseline CD4 cell count, HIV viral load, and IGRA status can be used to guide targeted TB preventive treatment in PLHIV in low-to-moderate TB burden settings where HAART is routinely provided to all PLHIV. The implementation of this algorithm will avoid unnecessary exposure of low-risk patients to drug toxicity and simultaneously, reduce the burden of universal treatment on the healthcare system.
Read more at: http://goo.gl/0XOsvZ MT @PLOSONE
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