Possibilities of the Enzyme-Linked Immunospot Assay (Elispot) method in carrying out anti-tuberculosis measures in patients with HIV infection

Abstract

Introduction. The problem of tuberculosis (TB), combined with HIV infection, currently occupies a central place in phthisiology. HIV infection significantly increases the risk of reactivation of latent tuberculosis infection to the clinical form of the disease, which requires a new approach to early detection of tuberculosis at the stage of development of latent tuberculosis infection (LTBI) in the most vulnerable group of patients. A key factor in the disruption of the immune defense mechanisms against tuberculosis, leading to the activation of LTBI, is a decrease in the number of CD4+-cells. For early detection of tuberculosis infection, including LTBI, immunodiagnostic tests based on the determination of the immune response to ESAT6-CFP10 proteins specific to the virulent MBT strain are currently available. According to many authors, the most effective method for early detection of TB in HIV-infected patients is the method of determining the number of mononuclear blood cells (spots) that release interferon γ (IFN-γ) in response to stimulation of ESAT-6 and CFP-10 and obtaining a cell suspension a certain concentration (ELISPOT) Assessment of the significance of the method in the diagnosis of tuberculosis infection in screening patients with different levels of immunosuppression seems relevant.

Aim of the study – to evaluate the results of T-SPOT.TB in patients with HIV infection with different levels of CD4+-cells, comparing them with other methods of detecting TB using the example of the Samara region.

Material and methods. In 2019–2020 an analysis of the T-SPOT.TB results was carried out in 398 patients with HIV infection who are under dispensary observation at the Center for the Prevention and Control of AIDS and Infectious Diseases. Inclusion criteria: age 18 years and older, diagnosis of HIV infection, CT scan of the lungs, the presence of a blood test for T-SPOT.TB, the presence of a test result with ATP.

Results. It was found that with changes on CT, characteristic of tuberculosis, out of 117 cases of verified tuberculosis in patients with CD4+-cells level 230.05 ± 15.3 CI [190.91–256.2], positive T-SPOT.TB was registered in 103 (88 %) patients. When comparing the results of the test with ATP and T-SPOT.TB at a CD4+-cells level of 500–350 cells/mcl, there was no statistically significant difference in the effectiveness of the tests (χ² = 1.28, p = 0.2579, OR = 2.28), with a decrease in the level of CD4+-cells less than 350 cells/μl, the role of T-SPOT.TB increases significantly. With a positive T-SPOT.TB result and no changes on CT, persons with suspected tuberculosis were diagnosed with LTBI in 17.6 %.

Conclusion. Immunodiagnostic tests can be used in a diagnostic complex for monitoring patients with HIV infections to detect tuberculosis infection, which will allow timely anti-tuberculosis measures.

Keywords:T-SPOT.TB; test with recombinant tuberculosis allergen; tuberculosis; diagnostics; HIV infection; AIDS center

For citation: Borodulina E.A., Kudlay D.A., Kuznetsova A.N., Doktorova N.P., Borodulin B.E., Kalashnikova E.V. Possibilities of the Enzyme-Linked Immunospot Assay (ELISPOT) method in carrying out anti-tuberculosis measures in patients with HIV infection. Immunologiya. 2021; 42 (5): 536-544. DOI: https://doi.org/10.33029/0206-4952-2021-42-5-536-544 (in Russian)

Funding. The study had no sponsor support.

Conflict of interests. Authors declare no conflict of interests.

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