Insight into the Associated Factors of Latent Tuberculosis Reactivation amongst Post-immunosuppressive Therapy Patients: A Systematic Review
Rana Alotaibi, Bander Alotaibi, Salma Alshahrani, Manal Alghamdi, Bushra Alqurashi, Hanan Mushaeb, Hanin Hakami, Manar Alsowaiei, Rana Albadrani, Rehab Alasiri, Raimaa Alhassan, Hanin Alhodathi, Leen Alhodathi, Hasan AlfahemiAbstract
Background:
Patients who undergo anti-TNF therapy or are otherwise immunosuppressed face a significantly increased risk of developing active tuberculosis if they already carry latent TB infection. LTBI is frequently seen in this group of patients receiving immunosuppressive treatment.
Objective:
The objective of the study was to evaluate the prevalence and risk factors of LTBI reactivation in patient’s post-IST with a systematic review.
Methodology:
A systematic search of multiple databases was conducted until November 2023. There were 35 studies eligible for inclusion, with publication years ranging between 2002 and 2023. Study quality was assessed using the Risk of Bias in Non-randomised Studies-of Intervention-I and Newcastle–Ottawa Scale tools. Due to heterogeneity between studies, the data were synthesised qualitatively.
Results:
Individuals receiving anti-TNF therapy and transplant recipients were found to have the greatest risk of LTBI reactivation. Diagnostic tools such as IGRA and TST were assessed, and although IGRA performance varied among immunocompromised adults, it showed better accuracy in younger age groups. The results highlight the need for consistent LTBI screening and tailored treatment plans, as patients on IST face a substantially higher chance of TB reactivation.
Conclusion:
This review highlights the importance of targeted active screening and treatment for LTBI post-IST. National data indicate that targeted screening and preventative approaches are associated with substantial tuberculosis (TB)-related sequelae. Further investigation through evidence-based protocols is needed to assess the TB-related complications and mortality associated with the screening of these vulnerable patients.