Tuberculin skin test conversion among HIV patients on antiretroviral therapy in Uganda
OBJECTIVE: To study the incidence of and factors associated with tuberculin skin test (TST) conversion in HIV patients on antiretroviral therapy (ART).
DESIGN: Prospective cohort study of TST-negative, ART-naïve HIV patients (CD4 cell count < 250 cells/l) without active TB. TST was repeated at 2 months and, if negative, at 6 months. TST positivity was defined as an induration of ≥5 mm. Clinical examination, chest X-ray and CD4 cell counts were performed at baseline and follow-up. Proportions and incidence of TST conversion were calculated, and logistic regression analyses were performed.
RESULTS: Of the 142 patients, 105 (75.5%) were females. The mean age was 35.9 years (standard deviation 8.1) and the median CD4 cell count was 119 cells/l (interquartile range 42168). The incidence of TST conversion was 30.2/100 person years (95%CI 19.546.8). Conversion was not associated with clinical, CD4 cell count or chest radiography findings.
CONCLUSIONS: A high incidence of TST conversion was observed, supporting the World Health Organization recommendation to provide isoniazid preventive therapy (IPT) to all HIV patients in high TB prevalence settings. If case-control programmes choose to provide IPT only to TST-positive patients, repeat TST should be considered following initiation of ART.
Keywords: anti-retroviral therapy; conversion; tuberculin skin test
Document Type: Research Article
Affiliations: 1: Pulmonology Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda; College of Health Sciences, Makerere University, Kampala, Uganda; and Infectious Diseases Network for Treatment and Research in Africa (INTERACT), Makerere University, Kampala, Uganda 2: Pulmonology Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda; Infectious Diseases Network for Treatment and Research in Africa (INTERACT), and Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda 3: Institute of Tropical Medicine, Antwerp, Belgium 4: Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda 5: Infectious Diseases Network for Treatment and Research in Africa (INTERACT), and Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 6: Institute of Tropical Medicine, Antwerp, Belgium; and University of Antwerp, Antwerp, Belgium
Publication date: March 1, 2013
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