Improved Screening for Recurrent Tuberculosis Needed in Adults Coinfected With HIV

Increased incidence rates of both recurrent clinical and subclinical tuberculosis (TB) infection were observed among patients coinfected with HIV, indicating a need for more effective symptoms-based screening efforts in settings with an increased burden of TB and HIV infection. These findings were published in Clinical Infectious Diseases.

Between 2009 and 2013, researchers conducted a prospective longitudinal cohort study among adults with TB and HIV coinfection in South Africa. All patients were receiving antiretroviral therapy (ART) and had successfully completed treatment for a previous pulmonary TB infection. The primary outcome was the incidence of recurrent TB infection, and the follow-up duration was 36 months.

Among a total of 402 patients included in the analysis, 48 were diagnosed with recurrent TB infection, the mean age was 38.2±9.1 years, 53.7% were women, and the median CD4 count was 453 cells/mm³.

Of patients diagnosed with recurrent TB infection, 17 (35.4%) had subclinical and 31 (64.5%) had clinical TB infection, with median ART durations of 3.3 (IQR, 2.3-4.0) and 4.3 (IQR, 3.0-5.1) years, respectively. The median time to diagnosis of recurrent TB infection was 41 (IQR, 30-54) months among all patients, and 34 (IQR, 26-43) and 45 (IQR, 32-57) in those with subclinical and clinical TB infection, respectively. In addition, the researchers found that the incidence rate of recurrent TB infection per 100 person-years was increased among patients with clinical infection (IR, 1.5; 95% CI, 1.1-2.2) vs those with subclinical infection (IR, 0.9; 95% CI, 0.5-1.4).

Compared with patients with clinical TB infection, the number of patients with an undetectable HIV viral load was increased among those with subclinical TB infection at both baseline (70.6% vs 61.3%) and at receipt of recurrent diagnosis (94.1% vs 70.0%).

Among all patients who developed recurrent TB infection, drug resistance was observed in 18.8%, of whom 6 and 3 had clinical and subclinical TB infection, respectively.

This study was limited by its small sample size. In addition, the findings may be generalizable to only patients with well-controlled HIV infection who have previously been infected with TB.

Findings from this study demonstrate “the cyclical nature of TB disease progression and need for reconsideration of current TB screening and testing guidelines,” the researchers concluded.

Disclosure: Some authors declared affiliations with industry. Please see the reference for a full list of disclosures.

Reference

Naidoo K, Moodley MC, Hassan-Moosa R, et al. Recurrent subclinical tuberculosis among ART accessing participants: incidence, clinical course, and outcomes. Clin Infect Diseas. Published online March 5, 2022. doi.10.1093/cid/ciac185