Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 15;13(11):e0207582.
doi: 10.1371/journal.pone.0207582. eCollection 2018.

A scoring strategy for progression risk and rates of treatment completion in subjects with latent tuberculosis

Michael Scolarici  1 , Ken Dekitani  1 , Ling Chen  2 , Marcia Sokol-Anderson  3 , Daniel F Hoft  3 , Soumya Chatterjee  3
Affiliations

A scoring strategy for progression risk and rates of treatment completion in subjects with latent tuberculosis

Michael Scolarici et al. PLoS One. .

Abstract

It is unknown whether patients with LTBI at high vs. low risk of developing active TB are currently adequately identified and treated in the US. In this study our objective was 1) To retrospectively apply the online calculator (tstin3d.com) to determine the probability of having LTBI and assign cumulative risk of progression. 2) Measure treatment outcomes in subjects with Low: 0-<10%, Intermediate: 10-<50% and High: 50-100% cumulative risk. We performed medical record review of tuberculin skin test and/or Interferon-γ release assay (IGRAs) positive patients with LTBI seen from 2010-2015. Of 125 subjects included, 51(41%), 46 (37%) and 28 (22%) subjects were in Low, Intermediate and High risk groups respectively. Tstin3d.com was useful in determining the probability of LTBI in tuberculin skin test positive US-born subjects. Overall treatment completion rate was 61% in 114 subjects with complete treatment information and similar completion rates were seen in the three groups (Low-60%, Intermediate-63% and High-57%). Provider assessment of important clinical risk factors was often incomplete. Logistic regression analysis showed no association of assessment of important risk factors with treatment completion. The major limitations of the calculator are the lack of an updated data on country-specific prevalence of TB disease as the global burden of TB continues to decrease as well as falsely high positive predictive values that due to "transiently" positive IGRA results in subjects from countries with low prevalence. Nonetheless, our findings suggest that tstin3d.com could be utilized in the US setting for improving providing awareness of risk stratification of patients with LTBI for short course treatment regimens based on risk.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Showing all subjects included in the study based on whether they had a tuberculin skin test (TST) performed.
Those who tested negative on TST or had no TST results available had to have a positive Interferon Gamma Release Assay (IGRA) i.e. Quantiferon-TB Gold or T-spot TB test to be included in the study.
Fig 2
Fig 2. Showing number of US born (black bars) vs. non-US born (grey bars) subjects with different risk factors for progression to active TB disease in the overall cohort of patients with latent TB.
Fig 3
Fig 3. Showing the number of patients discontinuing therapy and the primary documented causes by drug group.
See this image and copyright information in PMC

References

    1. Lobue P, Menzies D. Treatment of latent tuberculosis infection: An update. Respirology (Carlton, Vic). 2010;15(4):603–22. Epub 2010/04/23. 10.1111/j.1440-1843.2010.01751.x . - DOI - PubMed
    1. Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. The European respiratory journal. 2015;46(6):1563–76. 10.1183/13993003.01245-2015 PubMed PMID: PMC4664608. - DOI - PMC - PubMed
    1. Salinas JL, Mindra G, Haddad MB, Pratt R, Price SF, Langer AJ. Leveling of Tuberculosis Incidence—United States, 2013–2015. MMWR Morbidity and mortality weekly report. 2016;65(11):273–8. doi: 10.15585/mmwr.mm6511a2 - DOI - PubMed
    1. Li J, Munsiff SS, Tarantino T, Dorsinville M. Adherence to treatment of latent tuberculosis infection in a clinical population in New York City. International Journal of Infectious Diseases. 2010;14(4): e292–e7. 10.1016/j.ijid.2009.05.007 - DOI - PubMed
    1. Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morbidity and mortality weekly report. 2011;60(48):1650–3. Epub 2011/12/14. . - PubMed

Publication types