1651. Enhanced Compliance with Latent Tuberculosis Screening using an IGRA
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Finalized IGRA poster 1.pdf (357.9 kB)
  • Background: Screening for latent tuberculosis infection (LTBI) is recommended for all newly identified HIV-infected individuals, and then annually in patients at on-going high risk for exposure.  Although tuberculin skin testing (TST) has been the recommended assay, the interferon gamma release assay (IGRA) has been suggested as the preferred test in groups that have historically low rates of return to have TST’s interpreted.  The current study reports an analysis of completed TST’s vs. IGRA’s in an inner-city cohort of HIV-infected patients.

    Methods: An electronic medical record review was used to identify all patients with an ICD-9 code of 042 (HIV) who received care in our HIV clinic.  Patients were then randomly sampled from clinics held on 3 separate days, and demographic data, documentation of TST placement and interpretation were recorded.  A clinic-wide decision to institute IGRA testing was then implemented, and compliance with IGRA testing in those same clinics was prospectively recorded.

    Results: 224 patients were selected from 4 fellow and 1 attending staff’s continuity clinic.  The mean age was 44 years (+/- 11.5 ), with 49% male.  The mean CD4 496 (+/-302), with a mean HIV VL of 2.1 logs (=/-1.2).  Combing all clinics, 44.3% had documentation of appropriate TST placement and interpretation within the past year. Of note, 22.7% of patients who had a TST placed did not return for TST interpretation. After implantation of IGRA testing, 463 patients were reviewed, with a mean age of 46  years (+/- 22.8 ), 47% male, CD4 mean CD4 520 (+/-306), and HIV VL 1.9 logs (=/-1.1).  Compliance with IGRA screening was 94%, which was significantly greater than with TST screening (p=<0.001)

    Conclusion: Testing with interferon gamma release assays significantly enhanced LTBI screening as compared with tuberculin skin testing.   Given the complexities and low rate of return for TST interpretation, our findings support the recommendation to use the IGRAs for LTBI screening in groups with low rates of return.

    Suchita Mishra, MD, Glenn Wortmann, MD and Christian Woods, MD, Infectious Disease, Medstar Washington Hospital Center, Washington, DC

    Disclosures:

    S. Mishra, None

    G. Wortmann, None

    C. Woods, None

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