Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy
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{"title"=>"Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy", "type"=>"journal", "authors"=>[{"first_name"=>"Andrew D.", "last_name"=>"Kerkhoff", "scopus_author_id"=>"36140414100"}, {"first_name"=>"Katharina", "last_name"=>"Kranzer", "scopus_author_id"=>"23008694200"}, {"first_name"=>"Taraz", "last_name"=>"Samandari", "scopus_author_id"=>"6602412906"}, {"first_name"=>"Jessica", "last_name"=>"Nakiyingi-Miiro", "scopus_author_id"=>"8866822900"}, {"first_name"=>"Christopher C.", "last_name"=>"Whalen", "scopus_author_id"=>"7004888185"}, {"first_name"=>"Anthony D.", "last_name"=>"Harries", "scopus_author_id"=>"35233439700"}, {"first_name"=>"Stephen D.", "last_name"=>"Lawn", "scopus_author_id"=>"7006905471"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-84870261812", "doi"=>"10.1371/journal.pone.0049928", "sgr"=>"84870261812", "isbn"=>"1932-6203", "pmid"=>"23209621", "issn"=>"19326203", "pui"=>"366155953"}, "id"=>"733634c7-7b73-3f2d-bec8-f81cabc276ff", "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.\\n\\nMETHODOLOGY/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 <200, 200-499 or ≥500 cells/µL who tested positive were 12.4% (8.2-15.3%), 28.4% (20.1-36.9%) and 37.4% (31.3-56.3%), respectively. Heterogeneity in the data precluded calculation of pooled summary estimates.\\n\\nCONCLUSIONS/SIGNIFICANCE: In most settings, if IPT is administered to PLWH pre-ART without assessment of TST status, only a minority of those treated are likely to benefit, especially among those with the lowest CD4 cell counts. This may be inefficient use of resources and cost-effectiveness analyses should take this into account. Local knowledge of TST response rates may help inform policies. New simple means of identifying those who will benefit from IPT are needed to permit appropriate targeting of this intervention.", "link"=>"http://www.mendeley.com/research/systematic-review-tst-responses-people-living-hiv-underresourced-settings-implications-isoniazid-pre", "reader_count"=>70, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Researcher"=>21, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>4, "Student > Master"=>12, "Other"=>3, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Researcher"=>21, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>4, "Student > Master"=>12, "Other"=>3, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>7, "Agricultural and Biological Sciences"=>6, "Business, Management and Accounting"=>1, "Chemistry"=>1, "Computer Science"=>1, "Economics, Econometrics and Finance"=>1, "Engineering"=>3, "Environmental Science"=>1, "Nursing and Health Professions"=>2, "Mathematics"=>1, "Medicine and Dentistry"=>38, "Social Sciences"=>6, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>38}, "Social Sciences"=>{"Social Sciences"=>6}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>7}, "Environmental Science"=>{"Environmental Science"=>1}, "Engineering"=>{"Engineering"=>3}, "Chemistry"=>{"Chemistry"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>6}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}}, "reader_count_by_country"=>{"Netherlands"=>1, "United States"=>1, "Brazil"=>4}, "group_count"=>4}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/287845", "https://ndownloader.figshare.com/files/287897", "https://ndownloader.figshare.com/files/287961"], "description"=>"<div><h3>Background</h3><p>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.</p> <h3>Methodology/Principal Findings</h3><p>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 <200, 200–499 or ≥500 cells/µL who tested positive were 12.4% (8.2–15.3%), 28.4% (20.1–36.9%) and 37.4% (31.3–56.3%), respectively. Heterogeneity in the data precluded calculation of pooled summary estimates.</p> <h3>Conclusions/Significance</h3><p>In most settings, if IPT is administered to PLWH pre-ART without assessment of TST status, only a minority of those treated are likely to benefit, especially among those with the lowest CD4 cell counts. This may be inefficient use of resources and cost-effectiveness analyses should take this into account. Local knowledge of TST response rates may help inform policies. New simple means of identifying those who will benefit from IPT are needed to permit appropriate targeting of this intervention.</p> </div>", "links"=>[], "tags"=>["systematic", "tst", "responses", "hiv", "under-resourced", "implications", "isoniazid", "preventive", "therapy"], "article_id"=>116704, "categories"=>["Cancer", "Biotechnology"], "users"=>["Andrew D. Kerkhoff", "Katharina Kranzer", "Taraz Samandari", "Jessica Nakiyingi-Miiro", "Christopher C. Whalen", "Anthony D. Harries", "Stephen D. Lawn"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0049928.s001", "https://dx.doi.org/10.1371/journal.pone.0049928.s002", "https://dx.doi.org/10.1371/journal.pone.0049928.s003"], "stats"=>{"downloads"=>9, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Systematic_Review_of_TST_Responses_in_People_Living_with_HIV_in_Under_Resourced_Settings_Implications_for_Isoniazid_Preventive_Therapy__/116704", "title"=>"Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-11-27 01:51:44"}
  • {"files"=>["https://ndownloader.figshare.com/files/536663"], "description"=>"*<p>Denotes median age.</p><p>“…” denotes information not stated.</p><p>TU = tuberculin units; PPD = purified protein derivative; STD = sexually transmitted disease; MSM = men who have sex with men;</p><p>IDU = people who inject drugs; ART = antiretroviral therapy; IPT = isoniazid preventive therapy.</p>", "links"=>[], "tags"=>["studies", "presenting", "hiv", "tested", "tst-positive", "stratified", "cd4"], "article_id"=>207149, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Andrew D. Kerkhoff", "Katharina Kranzer", "Taraz Samandari", "Jessica Nakiyingi-Miiro", "Christopher C. Whalen", "Anthony D. Harries", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0049928.t001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_studies_presenting_data_on_the_proportion_of_people_living_with_HIV_who_tested_TST_positive_stratified_by_CD4_cell_counts_/207149", "title"=>"Characteristics of studies presenting data on the proportion of people living with HIV who tested TST-positive stratified by CD4 cell counts.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-27 01:59:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/536319"], "description"=>"<p>Forest plot showing the proportions (%, 95%CI) of people living with HIV testing TST-positive in the all studies (n = 19) with data grouped according to: a) geographical region; b) country TB prevalence (<100, 100–249 and ≥250 cases per 100,000 population) and c) CD4 cell count (<200 or ≥200 cells/µL).</p>", "links"=>[], "tags"=>["proportions", "hiv", "tst-positive", "studies", "grouped", "geographical", "tb", "prevalence", "cases", "cd4"], "article_id"=>206794, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Andrew D. Kerkhoff", "Katharina Kranzer", "Taraz Samandari", "Jessica Nakiyingi-Miiro", "Christopher C. Whalen", "Anthony D. Harries", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0049928.g002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_proportions_95_CI_of_people_living_with_HIV_testing_TST_positive_in_the_all_studies_n_8202_8202_19_with_data_grouped_according_to_a_geographical_region_b_country_TB_prevalence_lt_100_100_8211_249_and_8805_250_cases_per_100_000_pop/206794", "title"=>"Forest plot showing the proportions (%, 95%CI) of people living with HIV testing TST-positive in the all studies (n = 19) with data grouped according to: a) geographical region; b) country TB prevalence (<100, 100–249 and ≥250 cases per 100,000 population) and c) CD4 cell count (<200 or ≥200 cells/µL).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-11-27 01:53:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/536706"], "description"=>"<p>The proportion of people living with HIV who tested TST-positive stratified by CD4 cell count categories <200, ≥200, 200–499 and ≥500 cells/µL.</p>", "links"=>[], "tags"=>["hiv", "tested", "tst-positive", "stratified", "cd4", "categories"], "article_id"=>207191, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Andrew D. Kerkhoff", "Katharina Kranzer", "Taraz Samandari", "Jessica Nakiyingi-Miiro", "Christopher C. Whalen", "Anthony D. Harries", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0049928.t002", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_proportion_of_people_living_with_HIV_who_tested_TST_positive_stratified_by_CD4_cell_count_categories_lt_200_8805_200_200_8211_499_and_8805_500_cells_181_L_/207191", "title"=>"The proportion of people living with HIV who tested TST-positive stratified by CD4 cell count categories <200, ≥200, 200–499 and ≥500 cells/µL.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-27 01:59:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/536506"], "description"=>"<p>The median proportions testing positive in these three groups were 12.4% (range, 8.2–15.3%), 28.4% (range, 20.1–36.9%) and 37.4% (range, 31.3–56.3%). The I<sup>2</sup> statistics for these three groups of data were 54.4% (P = 0.067), 84.2% (P<0.001) and 86.8% (P<0.001), respectively.</p>", "links"=>[], "tags"=>["proportions", "hiv", "tst-positive", "studies", "included", "meta-analysis", "grouped", "cd4", "strata"], "article_id"=>206981, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Andrew D. Kerkhoff", "Katharina Kranzer", "Taraz Samandari", "Jessica Nakiyingi-Miiro", "Christopher C. Whalen", "Anthony D. Harries", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0049928.g003", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_showing_the_proportions_95_CI_of_people_living_with_HIV_testing_TST_positive_in_studies_n_8202_8202_5_included_in_the_meta_analysis_with_data_grouped_according_to_CD4_cell_count_strata_lt_200_200_8211_499_and_8805_500_cells_181_L_/206981", "title"=>"Forest plot showing the proportions (%, 95%CI) of people living with HIV testing TST-positive in studies (n = 5) included in the meta-analysis with data grouped according to CD4 cell count strata (<200, 200–499 and ≥500 cells/µL).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-11-27 01:56:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/536191"], "description"=>"<p>Selection of eligible studies containing data on the proportion of people living with HIV testing tuberculin skin test (TST)-positive stratified by blood CD4 cell count.</p>", "links"=>[], "tags"=>["studies", "containing", "hiv", "tuberculin", "stratified", "cd4"], "article_id"=>206678, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Andrew D. Kerkhoff", "Katharina Kranzer", "Taraz Samandari", "Jessica Nakiyingi-Miiro", "Christopher C. Whalen", "Anthony D. Harries", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0049928.g001", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Selection_of_eligible_studies_containing_data_on_the_proportion_of_people_living_with_HIV_testing_tuberculin_skin_test_TST_positive_stratified_by_blood_CD4_cell_count_/206678", "title"=>"Selection of eligible studies containing data on the proportion of people living with HIV testing tuberculin skin test (TST)-positive stratified by blood CD4 cell count.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-11-27 01:51:18"}

PMC Usage Stats | Further Information

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Relative Metric

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