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Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy

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  • Andrew D Kerkhoff
  • Katharina Kranzer
  • Taraz Samandari
  • Jessica Nakiyingi-Miiro
  • Christopher C Whalen
  • Anthony D Harries
  • Stephen D Lawn

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

Suggested Citation

  • Andrew D Kerkhoff & Katharina Kranzer & Taraz Samandari & Jessica Nakiyingi-Miiro & Christopher C Whalen & Anthony D Harries & Stephen D Lawn, 2012. "Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-12, November.
  • Handle: RePEc:plo:pone00:0049928
    DOI: 10.1371/journal.pone.0049928
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    References listed on IDEAS

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    1. Amitabh B Suthar & Stephen D Lawn & Julia del Amo & Haileyesus Getahun & Christopher Dye & Delphine Sculier & Timothy R Sterling & Richard E Chaisson & Brian G Williams & Anthony D Harries & Reuben M , 2012. "Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis," PLOS Medicine, Public Library of Science, vol. 9(7), pages 1-15, July.
    2. Elizabeth L Corbett & Tsitsi Bandason & Yin Bun Cheung & Shungu Munyati & Peter Godfrey-Faussett & Richard Hayes & Gavin Churchyard & Anthony Butterworth & Peter Mason, 2007. "Epidemiology of Tuberculosis in a High HIV Prevalence Population Provided with Enhanced Diagnosis of Symptomatic Disease," PLOS Medicine, Public Library of Science, vol. 4(1), pages 1-9, January.
    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Eva Van Ginderdeuren & Jean Bassett & Colleen F Hanrahan & Lillian Mutunga & Annelies Van Rie, 2021. "Novel health system strategies for tuberculin skin testing at primary care clinics: Performance assessment and health economic evaluation," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-15, February.

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