Female doctor talking to older male patient
TB Management
 

Immunocompromised

WHO recommends testing patients with weakened immune systems for TB infection.

Immunocompromised patients are at risk of TB

Overall, about 5–10% of people with latent TB infection will develop active TB disease at some time in their lives. The risk of active TB is greater in people suffering from conditions that impair the immune system.

Two such populations are people living with HIV and patients receiving biologics therapy:

  • People who are infected with HIV are 16 times more likely to develop active TB (1).
  • TB is the leading cause of death among HIV-infected patients (2).
  • Patients receiving biologic (anti-TNF-α) therapy are at a 9-fold increased relative risk of developing active TB (3).

Let’s see how systematic latent TB testing and treatment can prevent the progression of latent TB to TB disease in immunocompromised patients.

Ensure peace of mind for people with HIV

As a result of immunosuppression, people living with HIV are at increased risk for TB, and reliable surveillance is critical to protect their health.

Thus, timely diagnosis and early treatment are vital to preventing its progression to disease. The WHO recommends systematic latent TB testing and treatment for all persons living with HIV – regardless of country incidence or income (4).

Protect patients receiving biologic therapy

Treatment with biologic agents, in particular tumor necrosis factor-alpha (TNF-α) inhibitors, has revolutionized the treatment of autoimmune conditions like rheumatoid arthritis, Crohn’s disease and psoriasis.

However, patients receiving anti-TNF-α therapy are at increased risk of TB infection. The immune system, including TNF, suppresses latent TB infection, but when treated with anti-TNF-α, the immune system may lose control over TB infection, leading to TB activation.

To reduce this risk, the WHO recommends latent TB testing in patients starting biologics (4).

The WHO recommends IGRA testing using QuantiFERON technology

Patients with weakened immune systems should be tested for latent TB infection (4).

QuantiFERON TB testing employs a simple blood test (IGRA) to aid in the detection of Mycobacterium tuberculosis infection. In its Global Tuberculosis Report 2020, the WHO concludes that its previously endorsed QuantiFERON-TB Gold Plus (QFT-Plus) test is one of only two commercially available IGRAs that may be used for testing latent TB infection (4).

QFT-Plus can provide highly accurate detection of TB infection for immunocompromised patients in a single patient visit. It is unaffected by BCG vaccination, features innovative CD8 T cell technology and offers >94% sensitivity and >97% specificity.

QuantiFERON-TB Gold Plus tubes
Reduce the risk of active TB in immunocompromised patients
QFT-Plus is the modern alternative to the tuberculin skin test.
Find out more
References:
  1. World Health Organization. (2022) WHO Tuberculosis Key Facts. https://www.who.int/news-room/fact-sheets/detail/tuberculosis (accessed January 15, 2023)
  2. Machuca, I., Vidal, E., de la Torre-Cisneros, J., Rivero-Román, A. (2018). Tuberculosis in immunosuppressed patients. Enferm Infecc Microbiol Clin. 36(6), 366–374.
  3. Lobue, P. and Menzies, D. (2010) Treatment of latent tuberculosis infection: An update. Respirology. 15, 603.
  4. World Health Organization. (2020) WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. https://www.who.int/publications/i/item/who-consolidated-guidelines-ontuberculosis-module-1-prevention-tuberculosis-preventive-treatment

QuantiFERON-TB Gold Plus (QFT-Plus) is an in vitro diagnostic aid for detection of Mycobacterium tuberculosis infection. QFT-Plus is an indirect test for M. tuberculosis infection (including disease) and is intended for use in conjunction with risk assessment, radiography, and other medical and diagnostic evaluations. QFT-Plus Package Inserts as well as up-to-date licensing information and product-specific disclaimers can be found at www.QuantiFERON.com.