Assessment of tuberculosis disease activity in people infected with <i>Mycobacterium tuberculosis</i> and living with HIV: A longitudinal cohort study.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 35873194.
- Also identified by DOI 10.1016/j.eclinm.2022.101470 and PMC identifier 9305001.
- Licence recorded as CC BY-NC-ND.
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Abstract
Early detection of asymptomatic incipient tuberculosis (TB) could improve clinical outcomes and reduce the spread of <i>Mycobacterium tuberculosis (MTB)</i> infection, particularly in HIV endemic settings. This study assessed TB disease activity over 5 years in people living with HIV co-infected with <i>MTB</i> using a surrogate biomarker. Between Jan 1, 2013 and Aug 31, 2018, 2014 people living with HIV were screened annually for active TB using the Xpert MTB/RIF diagnostic assay in 11 clinics in Kenya, Tanzania, Uganda, and Nigeria. Longitudinal blood mononuclear cell samples from 46 selected patients with active and recurrent tuberculosis, latent infection, or incipient TB were further analysed for <i>MTB</i>-specific T-cell activation (defined by CD38 expression) as a well-defined surrogate marker for TB disease covering a total of 1758 person-months. <i>MTB</i>-specific CD4 T-cell activation differentiated active, Xpert MTB/RIF positive TB from latent TB with a sensitivity and specificity of 86% and was reduced upon TB treatment initiation. Activated <i>MTB-</i>specific T cells were present in 63% and 23% of incipient TB cases 6 and 12 months before diagnosis of active disease, respectively. Transient increases of <i>MTB</i>-specific T cell activation were also observed in individuals with latent infection, while persistent activation was a hallmark of recurrent TB after the end of treatment. In most cases, progression to active TB disease started 6-12 months before diagnosis by clinical symptoms and sputum occurrence of bacilli. Blood biomarkers could facilitate early detection of incipient TB, improve clinical outcomes, and reduce the transmission of <i>MTB</i>. This work was supported by the President's Emergency Plan for AIDS Relief via a cooperative agreement between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense [W81XWH-11-2-0174, W81XWH-18-2-0040] and by the Bundesministerium für Bildung und Forschung (BmBF) through funding of the Deutsches Zentrum für Infektionsforschung (DZIF, TTU-TB personalized medicine TTU 02_813).