AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS

Detalhes bibliográficos
Autor(a) principal: MARIA APARECIDA CAVICHIOLI DE SANTANA
Data de Publicação: 2022
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UFMS
Texto Completo: https://repositorio.ufms.br/handle/123456789/5469
Resumo: Tuberculosis (TB) is one of the main causes of death in people living with HIV/Aids (PLHA) and the treatment of latent infection by Mycobacterium tuberculosis (LTBI) is one of the pillars of TB control. We evaluated two different strategies for screening for LTBI in PLHA treated at an infectious disease referral center in Campo Grande, MS. Study participants were PLHA aged 18 years or older. Cases with active TB, previous LTBI treatment, tuberculin skin test (TST) performed less than 6 months ago, unavailability to return for TST reading and unavailability or impossibility of collecting blood to perform the interferon gamma release assay (IGRA) were excluded. IGRA with QuantiFERON® TB Gold Plus (QFT-Plus), TST and posteroanterior and lateral chest radiography were performed. Cases of LTBI were those with positive IGRA or positive TST (test in parallel) and ruled out active TB in the medical evaluation. A total of 296 participants were included, with a median age of 44 (IQR1 =33.3; IQR3= 54) years, with a predominance of men (60.8%), non-white (67.2%). They had a median CD4+ count of 556 (IQR1 =395; IQR3= 774.5) cells/mm³ and 88.2% had an undetectable viral load. The prevalence of LTBI was 15.9% (95% CI: 11.9% – 20.6%) TT positivity was 7.4% (95% CI: 4.7%-11.0%) and QFT-Plus was 12.8% (95% CI 9.3%-17.3%). The prevalence of LTBI was higher in those with a CD4+ count equal to or greater than 350 cells/mm3 than among those with a CD4+ count of less than 350 cells/mm3 (6.8% vs 18.1%; p=0.033). While TT positivity was more frequent in those with a CD4+ count equal to or greater than 350 cells/mm3 (p=0.010), this was not observed with the QFT-Plus (p=0.116). Thirty-four (11.5%) patients showed disagreement between the results of the IGRA and TST tests. The kappa coefficient of the tests revealed only a reasonable agreement (k=0.374, CI 95% 0.177 – 0.572; p=0.001). We did not observe associations between clinical and epidemiological variables and the occurrence of discordant tests. The IGRA identified more cases of LTBI when compared to the TST, however 9 of the 48 patients could only be diagnosed with LTBI by the TST. In conclusion, the use of the two tests, QFT-Plus and TT in parallel, in PLHA was able to detect more cases of LTBI than the TT alone and the results point to the superiority of QFT-Plus among those with CD4+.
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spelling 2022-12-16T18:04:45Z2022-12-16T18:04:45Z2022https://repositorio.ufms.br/handle/123456789/5469Tuberculosis (TB) is one of the main causes of death in people living with HIV/Aids (PLHA) and the treatment of latent infection by Mycobacterium tuberculosis (LTBI) is one of the pillars of TB control. We evaluated two different strategies for screening for LTBI in PLHA treated at an infectious disease referral center in Campo Grande, MS. Study participants were PLHA aged 18 years or older. Cases with active TB, previous LTBI treatment, tuberculin skin test (TST) performed less than 6 months ago, unavailability to return for TST reading and unavailability or impossibility of collecting blood to perform the interferon gamma release assay (IGRA) were excluded. IGRA with QuantiFERON® TB Gold Plus (QFT-Plus), TST and posteroanterior and lateral chest radiography were performed. Cases of LTBI were those with positive IGRA or positive TST (test in parallel) and ruled out active TB in the medical evaluation. A total of 296 participants were included, with a median age of 44 (IQR1 =33.3; IQR3= 54) years, with a predominance of men (60.8%), non-white (67.2%). They had a median CD4+ count of 556 (IQR1 =395; IQR3= 774.5) cells/mm³ and 88.2% had an undetectable viral load. The prevalence of LTBI was 15.9% (95% CI: 11.9% – 20.6%) TT positivity was 7.4% (95% CI: 4.7%-11.0%) and QFT-Plus was 12.8% (95% CI 9.3%-17.3%). The prevalence of LTBI was higher in those with a CD4+ count equal to or greater than 350 cells/mm3 than among those with a CD4+ count of less than 350 cells/mm3 (6.8% vs 18.1%; p=0.033). While TT positivity was more frequent in those with a CD4+ count equal to or greater than 350 cells/mm3 (p=0.010), this was not observed with the QFT-Plus (p=0.116). Thirty-four (11.5%) patients showed disagreement between the results of the IGRA and TST tests. The kappa coefficient of the tests revealed only a reasonable agreement (k=0.374, CI 95% 0.177 – 0.572; p=0.001). We did not observe associations between clinical and epidemiological variables and the occurrence of discordant tests. The IGRA identified more cases of LTBI when compared to the TST, however 9 of the 48 patients could only be diagnosed with LTBI by the TST. In conclusion, the use of the two tests, QFT-Plus and TT in parallel, in PLHA was able to detect more cases of LTBI than the TT alone and the results point to the superiority of QFT-Plus among those with CD4+.A tuberculose (TB) é uma das principais causas de óbito em pessoas vivendo com HIV/Aids (PVHA) e o tratamento da infecção latente por Mycobacterium tuberculosis (ILTB) é um dos pilares do controle da TB. Avaliamos duas diferentes estratégias para a triagem de ILTB em PVHA atendidas em centro de referência de doenças infecciosas em Campo Grande, MS. Os participantes do estudo eram PVHA com 18 anos ou mais. Foram excluídos casos com TB ativa; história de tratamento de ILTB; teste tuberculínico (TT) realizado há menos de 6 meses; indisponibilidade para retornar para leitura do TT e indisponibilidade ou impossibilidade de coleta de sangue para a realização do ensaio de liberação de interferon gama (IGRA). Foram realizados IGRA com QuantiFERON® TB Gold Plus (QFT-Plus), TT e radiografia de tórax posteroanterior e perfil. Foram considerados casos de ILTB aqueles com QFT-Plus positivo ou TT positivo e descartada TB ativa na avaliação médica e radiológica. Foram incluídos 296 participantes, com mediana de idade de 44 (IQR1 =33,3 e IQR3= 54) anos, com predomínio de homens (60,8%), não brancos (67,2%). Tinham mediana de contagem de CD4+ de 556 (IQR1 =395 e IQR3= 774,5) células/mm³ e 88,2% tinham carga viral não detectável. A prevalência de ILTB foi 15,9% (Intervalo de Confiança IC 95%: 11,9% – 20,6%). A positividade do TT foi de 7,4% (IC 95%: 4,7%-11,0%) e do QFT-Plus foi de 12,8% (IC 95% 9,3%- 17,3%). A prevalência de ILTB foi mais alta nos com contagem de CD4+ igual ou superior a 350 células/mm3 do que entre aqueles com CD4+ menor do que 350 células/mm3 (6,8% vs 18,1%; p=0,033). Enquanto a positividade do TT foi mais frequente nos com contagem de CD4+ igual ou superior a 350 células/mm3 (p=0,010), isso não foi observado com o QFT-Plus (p=0,116). Trinta e quatro (11,5%) pacientes apresentaram discordância entre os resultados dos testes IGRA e TT, sendo que 25 eram IGRA positivo e TT negativo e 9 eram IGRA negativo e TT positivo. O coeficiente kappa dos testes revelou uma concordância apenas razoável (k=0,374; IC95%: 0,177 – 0,572, p= 0,001). Não observamos associações entre variáveis clínicas e epidemiológicas e a ocorrência de testes discordantes. O IGRA identificou mais casos de ILTB quando comparado ao TT, no entanto 9 dos 48 pacientes só puderam ser diagnosticados com ILTB pelo TT. Conclui-se que a utilização dos dois testes, QFT-Plus e TT em paralelo, em PVHA foi capaz de detectar mais casos de ILTB do que o TT isoladamente e os resultados apontam para a superioridade do QFT-Plus entre os com CD4+.Fundação Universidade Federal de Mato Grosso do SulUFMSBrasilTuberculose latente. HIV. Testes de liberação de interferon-gama.AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDSinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisAnamaria Mello Miranda PaniagoMARIA APARECIDA CAVICHIOLI DE SANTANAinfo:eu-repo/semantics/openAccessporreponame:Repositório Institucional da UFMSinstname:Universidade Federal de Mato Grosso do Sul (UFMS)instacron:UFMSORIGINALDISSERTAÇÃO_Maria Aparecida Cavichioli de Santana.pdfDISSERTAÇÃO_Maria Aparecida Cavichioli de Santana.pdfapplication/pdf4710632https://repositorio.ufms.br/bitstream/123456789/5469/-1/DISSERTA%c3%87%c3%83O_Maria%20Aparecida%20Cavichioli%20de%20Santana.pdf5205aa90da753a41a534f1daa60ce2ecMD5-1123456789/54692022-12-16 14:04:46.493oai:repositorio.ufms.br:123456789/5469Repositório InstitucionalPUBhttps://repositorio.ufms.br/oai/requestri.prograd@ufms.bropendoar:21242022-12-16T18:04:46Repositório Institucional da UFMS - Universidade Federal de Mato Grosso do Sul (UFMS)false
dc.title.pt_BR.fl_str_mv AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
title AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
spellingShingle AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
MARIA APARECIDA CAVICHIOLI DE SANTANA
Tuberculose latente. HIV. Testes de liberação de interferon-gama.
title_short AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
title_full AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
title_fullStr AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
title_full_unstemmed AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
title_sort AVALIAÇÃO DE ESTRATÉGIAS DE RASTREAMENTO PARA DIAGNÓSTICO DE INFECÇÃO LATENTE POR MYCOBACTERIUM TUBERCULOSIS EM PESSOAS VIVENDO COM HIV/AIDS
author MARIA APARECIDA CAVICHIOLI DE SANTANA
author_facet MARIA APARECIDA CAVICHIOLI DE SANTANA
author_role author
dc.contributor.advisor1.fl_str_mv Anamaria Mello Miranda Paniago
dc.contributor.author.fl_str_mv MARIA APARECIDA CAVICHIOLI DE SANTANA
contributor_str_mv Anamaria Mello Miranda Paniago
dc.subject.por.fl_str_mv Tuberculose latente. HIV. Testes de liberação de interferon-gama.
topic Tuberculose latente. HIV. Testes de liberação de interferon-gama.
description Tuberculosis (TB) is one of the main causes of death in people living with HIV/Aids (PLHA) and the treatment of latent infection by Mycobacterium tuberculosis (LTBI) is one of the pillars of TB control. We evaluated two different strategies for screening for LTBI in PLHA treated at an infectious disease referral center in Campo Grande, MS. Study participants were PLHA aged 18 years or older. Cases with active TB, previous LTBI treatment, tuberculin skin test (TST) performed less than 6 months ago, unavailability to return for TST reading and unavailability or impossibility of collecting blood to perform the interferon gamma release assay (IGRA) were excluded. IGRA with QuantiFERON® TB Gold Plus (QFT-Plus), TST and posteroanterior and lateral chest radiography were performed. Cases of LTBI were those with positive IGRA or positive TST (test in parallel) and ruled out active TB in the medical evaluation. A total of 296 participants were included, with a median age of 44 (IQR1 =33.3; IQR3= 54) years, with a predominance of men (60.8%), non-white (67.2%). They had a median CD4+ count of 556 (IQR1 =395; IQR3= 774.5) cells/mm³ and 88.2% had an undetectable viral load. The prevalence of LTBI was 15.9% (95% CI: 11.9% – 20.6%) TT positivity was 7.4% (95% CI: 4.7%-11.0%) and QFT-Plus was 12.8% (95% CI 9.3%-17.3%). The prevalence of LTBI was higher in those with a CD4+ count equal to or greater than 350 cells/mm3 than among those with a CD4+ count of less than 350 cells/mm3 (6.8% vs 18.1%; p=0.033). While TT positivity was more frequent in those with a CD4+ count equal to or greater than 350 cells/mm3 (p=0.010), this was not observed with the QFT-Plus (p=0.116). Thirty-four (11.5%) patients showed disagreement between the results of the IGRA and TST tests. The kappa coefficient of the tests revealed only a reasonable agreement (k=0.374, CI 95% 0.177 – 0.572; p=0.001). We did not observe associations between clinical and epidemiological variables and the occurrence of discordant tests. The IGRA identified more cases of LTBI when compared to the TST, however 9 of the 48 patients could only be diagnosed with LTBI by the TST. In conclusion, the use of the two tests, QFT-Plus and TT in parallel, in PLHA was able to detect more cases of LTBI than the TT alone and the results point to the superiority of QFT-Plus among those with CD4+.
publishDate 2022
dc.date.accessioned.fl_str_mv 2022-12-16T18:04:45Z
dc.date.available.fl_str_mv 2022-12-16T18:04:45Z
dc.date.issued.fl_str_mv 2022
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.uri.fl_str_mv https://repositorio.ufms.br/handle/123456789/5469
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dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.publisher.none.fl_str_mv Fundação Universidade Federal de Mato Grosso do Sul
dc.publisher.initials.fl_str_mv UFMS
dc.publisher.country.fl_str_mv Brasil
publisher.none.fl_str_mv Fundação Universidade Federal de Mato Grosso do Sul
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