HIV-infection leads to a higher risk of progression from asymptomatic, non-transmissible latent tuberculosis infection (LTBI) to active tuberculosis (TB). Specific comorbid medical risk factors increase this risk which can be decreased by successfully treating LTBI.
We compared risk of progression between HIV infected and uninfected adults seen at the Saint Louis University hospital from 2010 to 2015 using a validated online calculator (tstin3d.com). We also recorded information on prescribing practices and treatment completion rates in the two groups.
Of 125 patients included, 10 had HIV, 10 AIDS, and 105 HIV-uninfected. The median annual TB-risk amongst the three groups was 8% (3-8%), 22% (21-25%), and 0.5% (0-6%) respectively. Smoking, recent TST/IGRA conversion, and diabetes were more prevalent among HIV/AIDS patients. Nine months of INH was most commonly prescribed for both HIV/AIDS (85%) and HIV-uninfected groups (45%). Of concern, were the equivalent rates of LTBI treatment non-completion seen between HIV/AIDS than HIV-uninfected patients (35% vs. 34%).
TSTin3D.com can facilitate increased provider awareness of TB activation risk factors and can quantitate risk of reactivation. We are currently implementing the calculator in the clinic to prospectively study how risk stratification can alter treatment choices for LTBI patients at highest risk for progression to TB.
S. Chatterjee, None