Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy

 

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dc.contributor.author Kerkhoff, Andrew D en_ZA
dc.contributor.author Kranzer, Katharina en_ZA
dc.contributor.author Samandari, Taraz en_ZA
dc.contributor.author Nakiyingi-Miiro, Jessica en_ZA
dc.contributor.author Whalen, Christopher C en_ZA
dc.contributor.author Harries, Anthony D en_ZA
dc.contributor.author Lawn, Stephen D en_ZA
dc.date.accessioned 2015-11-23T12:28:32Z
dc.date.available 2015-11-23T12:28:32Z
dc.date.issued 2012 en_ZA
dc.identifier.citation Kerkhoff, A. D., Kranzer, K., Samandari, T., Nakiyingi-Miiro, J., Whalen, C. C., Harries, A. D., & Lawn, S. D. (2011). Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy. PloS one, 7(11), e49928. doi:10.1371/journal.pone.0049928 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15291
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0049928
dc.description.abstract BACKGROUND: People living with HIV (PLWH) who have positive tuberculin skin tests (TST) benefit from isoniazid preventive therapy (IPT) whereas those testing TST-negative do not. Revised World Health Organization guidelines explicitly state that assessment of TST is not a requirement for initiation of IPT. However, it is not known what proportions of patients will benefit from IPT if implemented without targeting according to TST status. We therefore determined the proportions of PLWH who test TST-positive. METHODOLOGY/PRINCIPAL FINDINGS: We systematically reviewed the literature published between January 1990 and February 2012 to determine the proportions of patients without active tuberculosis attending HIV care services in low and middle-income countries who tested TST-positive (≥5 mm induration). Proportions were also determined for different CD4 count strata. Data from 19 studies with 9,478 PLWH from sub-Saharan Africa, Asia and Central and South America were summarized. The vast majority were not receiving antiretroviral therapy (ART). A sub-analysis was conducted of 5 studies (5,567 subjects) from high TB prevalence countries of PLWH with negative TB screens attending HIV care and treatment settings for whom CD4 stratified data were available. The median proportion of PLWH testing TST-positive overall was 22.8% (range, 19.5-32.6%). The median (range) proportions with CD4 cell counts of <200, 200-499 or ≥500 cells/µL who tested positive were 12.4% (8.2-15.3%), 28.4% (20.1-36.9%) and 37.4% (31.3-56.3%), respectively. Heterogeneity in the data precluded calculation of pooled summary estimates. Conclusions/Significance In most settings, if IPT is administered to PLWH pre-ART without assessment of TST status, only a minority of those treated are likely to benefit, especially among those with the lowest CD4 cell counts. This may be inefficient use of resources and cost-effectiveness analyses should take this into account. Local knowledge of TST response rates may help inform policies. New simple means of identifying those who will benefit from IPT are needed to permit appropriate targeting of this intervention. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Meta-analysis en_ZA
dc.subject.other HIV clinical manifestations en_ZA
dc.subject.other Sputum en_ZA
dc.subject.other Isoniazid en_ZA
dc.subject.other Cost-effectiveness analysis en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.title Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2012 Kerkhoff et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Desmond Tutu HIV Centre en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Kerkhoff, A. D., Kranzer, K., Samandari, T., Nakiyingi-Miiro, J., Whalen, C. C., Harries, A. D., & Lawn, S. D. (2012). Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy. <i>PLoS One</i>, http://hdl.handle.net/11427/15291 en_ZA
dc.identifier.chicagocitation Kerkhoff, Andrew D, Katharina Kranzer, Taraz Samandari, Jessica Nakiyingi-Miiro, Christopher C Whalen, Anthony D Harries, and Stephen D Lawn "Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/15291 en_ZA
dc.identifier.vancouvercitation Kerkhoff AD, Kranzer K, Samandari T, Nakiyingi-Miiro J, Whalen CC, Harries AD, et al. Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy. PLoS One. 2012; http://hdl.handle.net/11427/15291. en_ZA
dc.identifier.ris TY - Journal Article AU - Kerkhoff, Andrew D AU - Kranzer, Katharina AU - Samandari, Taraz AU - Nakiyingi-Miiro, Jessica AU - Whalen, Christopher C AU - Harries, Anthony D AU - Lawn, Stephen D AB - BACKGROUND: People living with HIV (PLWH) who have positive tuberculin skin tests (TST) benefit from isoniazid preventive therapy (IPT) whereas those testing TST-negative do not. Revised World Health Organization guidelines explicitly state that assessment of TST is not a requirement for initiation of IPT. However, it is not known what proportions of patients will benefit from IPT if implemented without targeting according to TST status. We therefore determined the proportions of PLWH who test TST-positive. METHODOLOGY/PRINCIPAL FINDINGS: We systematically reviewed the literature published between January 1990 and February 2012 to determine the proportions of patients without active tuberculosis attending HIV care services in low and middle-income countries who tested TST-positive (≥5 mm induration). Proportions were also determined for different CD4 count strata. Data from 19 studies with 9,478 PLWH from sub-Saharan Africa, Asia and Central and South America were summarized. The vast majority were not receiving antiretroviral therapy (ART). A sub-analysis was conducted of 5 studies (5,567 subjects) from high TB prevalence countries of PLWH with negative TB screens attending HIV care and treatment settings for whom CD4 stratified data were available. The median proportion of PLWH testing TST-positive overall was 22.8% (range, 19.5-32.6%). The median (range) proportions with CD4 cell counts of <200, 200-499 or ≥500 cells/µL who tested positive were 12.4% (8.2-15.3%), 28.4% (20.1-36.9%) and 37.4% (31.3-56.3%), respectively. Heterogeneity in the data precluded calculation of pooled summary estimates. Conclusions/Significance In most settings, if IPT is administered to PLWH pre-ART without assessment of TST status, only a minority of those treated are likely to benefit, especially among those with the lowest CD4 cell counts. This may be inefficient use of resources and cost-effectiveness analyses should take this into account. Local knowledge of TST response rates may help inform policies. New simple means of identifying those who will benefit from IPT are needed to permit appropriate targeting of this intervention. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0049928 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy TI - Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy UR - http://hdl.handle.net/11427/15291 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.