Female doctor talking to older male patient
Prise en charge de la tuberculose (TB)
 

Immunodépression

L’OMS recommande de soumettre les patients dont le système immunitaire est affaibli à un test de dépistage de la TB.

Les patients immunodéprimés sont à risque de TB

Overall, about 5–10% of people with latent TB infection will develop active TB disease at some time in their lives. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with normal immune systems (1).

  • People who are infected with HIV are 16 times more likely to develop active TB (2).
  • TB is the leading cause of death among HIV-infected patients (3).

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

Rassurer les patients porteurs du VIH

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 CDC recommends latent TB testing for all persons living with HIV as someone with untreated latent TB infection and HIV infection is much more likely to develop active TB disease during their lifetime than someone without HIV infection (5).

Prise en charge de la TB et du VIH pendant la pandémie de COVID-19

La pandémie de COVID-19 a engendré une crise mondiale avec des conséquences multiples sur la santé et l’économie, notamment sur les services liés à la TB et au VIH. Écoutez le Dr Sonia Qasba parler du dépistage de l’infection tuberculeuse et de la prévention durant cette période, ainsi que des tendances américaines et mondiales en matière d’épidémiologie liée au COVID-19.

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Man sitting with surfboard at the beach, evening, smile, satisfied, male, caucasian, QFT, QuantiFeron, TB testing, HIV

Protéger les patients sous biothérapie

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, pharmaceutical labeling requirements reinforce that TB testing is essential in evaluating a patient’s treatment options.

L’OMS recommande un test IGRA utilisant la technologie QuantiFERON.

Patients with weakened immune systems should be tested for latent TB infection (6).

QuantiFERON TB testing employs a simple blood test (IGRA) to aid in the detection of Mycobacterium tuberculosis infection. The CDC preferentially recommends TB testing with IGRAs, like QuantiFERON-TB Gold Plus (QFT-Plus), instead of the TB skin test for the majority of the US testing population (7).

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
Limiter le risque de TB active chez les patients immunodéprimés
Le QFT-Plus est une alternative moderne au test cutané à la tuberculine.
En savoir plus
References:
  1. Centers for Disease Control and Prevention. (2016) TB Risk Factors. https://www.cdc.gov/tb/topic/basics/risk.htm (accessed January 15, 2023)
  2. World Health Organization. (2022) WHO Tuberculosis Key Facts. https://www.who.int/news-room/fact-sheets/detail/tuberculosis (accessed January 15, 2023)
  3. 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.
  4. Lobue, P. and Menzies, D. (2010) Treatment of latent tuberculosis infection: An update. Respirology. 15, 603.
  5. Centers for Disease Control and Prevention. (2014) TB and HIV Coinfection. https://www.cdc.gov/tb/publications/pamphlets/tb_hivcoinfection (accessed January 15, 2023)
  6. World Health Organization. (2020) WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. https://apps.who.int/iris/bitstream/handle/10665/331525/9789240002906-eng.pdf
  7. Lewinsohn, D.M., et al. (2017) Official ATS/IDSA/CDC clinical practice guidelines: Diagnosis of tuberculosis in adults and children. Clin. Infect. Dis. 64, 111–116.

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.