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Public Library of Science, PLoS ONE, 8(10), p. e0135801, 2015

DOI: 10.1371/journal.pone.0135801

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A clinical algorithm to identify HIV patients at high risk for incident active tuberculosis: A prospective 5-year cohort study

Journal article published in 2015 by Susan Shin-Jung Lee, Hsi-Hsun Lin, Hung-Chin Tsai, Ih-Jen Su, Chin-Hui Yang, Hsin-Yun Sun ORCID, Chien-Chin Hung, Cheng-Len Sy, Kuan-Sheng Wu, Jui-Kuang Chen, Yao-Shen Chen, Chi-Tai Fang, SS;Lin HH;Tsai HC;Su IJ;Yang CH;Sun HY;Hung CC;Sy CL;Wu KS;Chen JK;Chen YS;Fang CT Lee
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

BACKGROUND: Predicting the risk of tuberculosis (TB) in people living with HIV (PLHIV) using a single test is currently not possible. We aimed to develop and validate a clinical algorithm, using baseline CD4 cell counts, HIV viral load (pVL), and interferon-gamma release assay (IGRA), to identify PLHIV who are at high risk for incident active TB in low-to-moderate TB burden settings where highly active antiretroviral therapy (HAART) is routinely provided. MATERIALS AND METHODS: A prospective, 5-year, cohort study of adult PLHIV was conducted from 2006 to 2012 in two hospitals in Taiwan. HAART was initiated based on contemporary guidelines (CD4 count /= 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/muL and pVL