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- Klinische proef NCT02712671
Testing for Tuberculosis in the United Kingdom HIV Infected Population
Study of Systematic Tuberculosis Testing for Active, Sub-clinical and Latent Tuberculosis Infection in a United Kingdom Human Immunodeficiency Virus (HIV) Infected Cohort
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
The investigators would like to assess a cohort of human immunodeficiency virus (HIV) infected individuals at the Ian Charleson Centre, Royal Free Hospital to assess the rates of latent tuberculosis infection (LTBI) using both tuberculin skin test (TST) and interferon gamma release assay (IGRA), systematically investigating for active tuberculosis (TB) with a symptom questionnaire and chest X ray, and test for Mycobacterium tuberculosis (MTb) in their sputum, both coughed up spontaneously where possible and by inducing sputum using a saline nebuliser and testing this using microscopy and culture (the established method for detecting MTb), nucleic acid amplification testing (using Xpert.TB, a new genetic test for TB that decreases the time required for detection) and a novel 16S ribosomal ribonucleic acid (RNA) test, used to look for TB burden.
A cohort of people with HIV infection will be invited to take part in the study. Subjects will have varying place of origin, TB exposure risk, blood cluster of differentiation 4 (CD4) cell count, HIV viral load, exposure to antiretroviral drugs used to treat HIV. All patients with a new diagnosis of HIV will be invited, as will a group of subjects already undergoing HIV care (selected by stratified sampling) in order to recruit 180 subjects originating from sub-Saharan African countries and 120 from lower TB incidence countries (such as the United Kingdom, UK and Western Europe). The study is powered to detect a difference between all forms of TB infection in subjects from sub-Saharan Africa to those from the UK (or other low TB prevalence countries) with 80% power, allowing a 5% type I error.
The participants will be recruited and a questionnaire, X ray, sputum induction, TST and IGRA can be taken in one visit. They will need to return 48--72 hours later to have the TST read on their arm. Those with evidence of LTBI (with positive TST or IGRA) will be invited to TB/HIV clinic and quality of life scores recorded as part of the study.
Research Questions:
- To determine the feasibility, yield and cost--effectiveness of testing for M. tuberculosis infection in UK HIV infected individuals.
- To determine the prevalence of subclinical and active TB in a UK HIV infected clinic
- To determine the sensitivity and specificity of systematic screening questionnaires for detecting cases of active TB outside of high TB prevalence settings
- To determine concordance between TST and blood IGRA (T-Spot.TB) in latent TB infection
- To identify risk factors for latent TB infection in the clinic population
- To determine the underlying frequency of airways disease (using spirometry) and of respiratory symptoms
- To determine the sensitivity and specificity of 'Xpert MTB/RIF' polymerase chain reaction (PCR) testing of sputum and induced sputum compared to mycobacterial microscopy and culture
- To compare the Molecular Bacterial Load (MBL) assay, based on 16S rRNA, and other available molecular assays, with Xpert MTB/RIF for detection of Mtb
To determine quality of life scores (EQ-5D) for those with HIV infection, with and without latent TB infection and/or undergoing treatment
On those with evidence of LTBI:
- To determine uptake of latent TB therapy (6 months isoniazid treatment)
- To determine cost of latent TB treatment (including screening costs, clinic time)
- To determine quality of life and rate and severity of adverse events on latent TB treatment
To determine rate and time until active TB in those with LTBI on or off antiretroviral therapy (ART) and/or isoniazid prophylaxis
In all patients (over 20 year follow up):
- To determine the rate of incident active TB
- To determine the time until progression to active TB with in patients with abnormal radiographic changes consistent with old tuberculosis exposure or disease
Data will be generated by the Research team and University College London (UCL) Statistics team.
Studietype
Inschrijving (Verwacht)
Contacten en locaties
Studie Locaties
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London, Verenigd Koninkrijk, NW3 2QG
- Ian Charleson Centre, Royal Free Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Bemonsteringsmethode
Studie Bevolking
Beschrijving
Inclusion Criteria:
- New diagnosis of HIV or established in care in HIV clinic by stratified sampling
- Able to give informed consent
Exclusion Criteria:
- Diagnosis of active TB or undergoing treatment for active or latent TB
- Inability to produce sputum by coughing (e.g. recent rib fracture, chest pain, pneumothorax)
- Pregnancy
- Use of steroids (equivalent to 15mg prednisolone for ≥4 weeks) or any other immunosuppressive drugs (e.g. azathioprine) - relative
- Active solid organ or haematological malignancy (excluding Kaposi's sarcoma)
- Previous hypersensitivity to purified protein derivative (PPD)
- Extensive eczema
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Observatiemodellen: Cohort
- Tijdsperspectieven: Prospectief
Cohorten en interventies
Groep / Cohort |
Interventie / Behandeling |
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Enrolled subjects
Subjects attending the Ian Charleson Centre and agreeing to be tested for latent, subclinical and active tuberculosis using Chest radiograph, Blood interferon gamma release assay, Tuberculin skin testing, Sputum induction for mycobacterial microscopy and culture with spirometry, and Mycobacterium tuberculosis polymerase chain reaction testing.
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A chest radiograph involves the participant standing in front of a film and a low dose of radiation passes through the chest.
This will be used to look for evidence of tuberculosis infection.
Andere namen:
Test of T-lymphocytes' response to exposure with tuberculosis antigens.
This test is used for the diagnosis of latent tuberculosis infection and involves a blood sample in lithium heparin tube.
It will be performed in an off site laboratory (Oxford Immunotec, Abingdon, Oxfordshire, United Kingdom).
Andere namen:
An intradermal test for latent tuberculosis infection that involves a small injection of purified protein derivative (PPD) from inactivated Mycobacterium tuberculosis.
The reaction is interpreted at 48-72 hours by measuring the induration produced.
Andere namen:
Participants will breathe in a nebuliser salt solution (3.5% normal saline) for 15 minutes and asked to cough up a sputum sample.
This is undertaken in a negative pressure tent.
The sample will be tested for mycobacteria under the microscope and then cultured for 42 days in liquid culture bottles the microbiology laboratory.
Sputum from sputum induction will be tested using the GeneXpert system using polymerase chain reaction to identify genes present in Mycobacterium tuberculosis.
This test is performed in a microbiology laboratory and tests for the presence of Mycobacterium tuberculosis in sputum, plus genes associated with drug resistance.
Andere namen:
Participants will be asked to blow into a spirometer to measure how much air they can expel in one second and in a whole breath.
This will be repeated six times (three times before inhaling 3.5% saline solution and three times five minutes after breathing 3.5% saline solution).
The results will be used to identify those whose airways are sensitive to the solution and to look for the presence of airways disease (asthma or chronic obstructive pulmonary disease).
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Number of cases of active tuberculosis disease
Tijdsspanne: 1 year
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Number of cases of active TB disease amongst the enrolled subjects, defined by the number of participants with X ray changes consistent with active tuberculosis and/or sputum culture positive for Mycobacterium tuberculosis with symptoms consistent with tuberculosis disease.
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1 year
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Number of cases of subclinical tuberculosis
Tijdsspanne: 1 year
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Number of cases of subclinical tuberculosis amongst the enrolled subjects, defined by the number of participants with sputum culture positive for Mycobacterium tuberculosis, with or without X ray changes consistent with active tuberculosis and without symptoms consistent with tuberculosis disease.
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1 year
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Number of cases latent tuberculosis infection
Tijdsspanne: 1 year
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Number of cases of latent tuberculosis infection amongst the enrolled subjects, defined by the number of participants with with positive tuberculin skin test (TST) and/or interferon gamma release assay (IGRA) (for latent TB infection), but without a history of previous, treated tuberculosis disease and without symptoms, X ray changes consistent with active tuberculosis disease or sputum culture positive for Mycobacterium tuberculosis.
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1 year
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Number with subsequent active TB disease
Tijdsspanne: 20 years
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Number of participants that develop new TB disease after the testing period has taken place
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20 years
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Time to subsequent active TB disease
Tijdsspanne: 20 years
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Time (months) from when testing took place to subsequent active TB disease in those that develop it.
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20 years
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Number of participants with a diagnosis of airways disease in an HIV infected cohort
Tijdsspanne: 2 years
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Number of participants with symptoms of airways disease (asthma or chronic obstructive pulmonary disease) defined as Forced Expiratory Volume in one second divided by the forced vital capacity <0.7 on spirometry and respiratory symptoms.
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2 years
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Quality of life scores for those with HIV infection with or without TB infection.
Tijdsspanne: 2 years
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Quality of life scores using the EuroQol 5 Dimensions (EQ5D) questionnaire for those with HIV infection, with and without latent TB infection and/or undergoing treatment.
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2 years
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Uptake of latent TB preventive treatment in an HIV clinic cohort
Tijdsspanne: 2 years
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Number of participants that agree to take latent tuberculosis preventive therapy in those with a new diagnosis of latent TB infection divided by the number of patients with a new diagnosis of latent tuberculosis infection.
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2 years
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Cost of latent TB preventive treatment in an HIV clinic cohort
Tijdsspanne: 2 years
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The sum of the costs (£ sterling) associated with preventive treatment for latent tuberculosis infection divided by the number of participants with a diagnosis of latent tuberculosis infection, measured from a United Kingdom National Health Service perspective.
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2 years
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Number of adverse events for each participant taking latent TB preventive treatment
Tijdsspanne: 2 years
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Number and type of adverse events whilst taking latent tuberculosis preventive therapy, measured using standardised adverse effects questionnaires.
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2 years
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Marc Lipman, MD, Clinical Senior Lecturer and Consultant Physician
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Verwacht)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Infecties
- Bacteriële infecties
- Bacteriële infecties en mycosen
- Gram-positieve bacteriële infecties
- Actinomycetales-infecties
- Mycobacterium-infecties
- Latente infectie
- Tuberculose
- Latente tuberculose
- Anti-infectieuze middelen
- Antivirale middelen
- Antineoplastische middelen
- Interferonen
- Interferon-gamma
Andere studie-ID-nummers
- UCL 12/0212
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Informatie over medicijnen en apparaten, studiedocumenten
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