title: Low sensitivity of T-cell based detection of tuberculosis among HIV co-infected Tanzanian in-patients.
abstract: OBJECTIVE
  To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting among patients with and without HIV infection.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Two hospitals in Northern Tanzania.
  
  
  METHODS
  Eighty three adult male and female inpatients.
  
  
  METHODS
  All patients were screened for HIV infection and underwent tuberculin skin test (TST) and QFTG.
  
  
  RESULTS
  Eighty-three subjects were enrolled, and 29 (35%) of 83 were HIV-infected. QFTG yielded indeterminate results in 12 (22%; 95% CI 12%-34%) of 54 HIV-uninfected and 13 (45%; 95% CI 26%-64%) of 29 HIV-infected subjects (p = 0.0323). Among those with smear-positive pulmonary tuberculosis, TST was positive in 40 (100%; 95% CI 91%-100%) of 40 HIV-uninfected subjects compared with seven (54%; 95% CI 25%-81%) of 13 HIV-infected subjects (p < 0.0001), and QFTG was positive in 28 (70%; 95% CI 53%-83%) of 40 HIV-uninfected subjects compared with three (23%; 95% CI 5%-54%) of 13 HIV-infected subjects (p = 0.0029). Among medical inpatients at risk for latent tuberculosis infection, TST was positive in seven (50%) of 14 HIV-uninfected patients and three (19%) of 16 HIV-infected patients (p = 0.0701) and QFTG was positive among two (14%) of 14 HIV-uninfected patients and three (19%) of 16 HIV-infected patients (p = 0.7437).
  
  
  CONCLUSIONS
  The presence of HIV co-infection was associated with a significant reduction in sensitivity of both the TST (p < 0.0001) and QFTG (p = 0.0029) for the diagnosis of active M. tuberculosis infection. The high proportion of indeterminate QFTG and lack of sensitivity, particularly among HIV-infected patients, may limit its applicability in settings like Tanzania. Larger studies in resource-poor settings are required.
authors.affiliation: Massachusetts General Hospital, Gray/Jackson 504, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: C
authors.initials: C
authors.lastname: Seshadri
authors.forename: L O
authors.initials: LO
authors.lastname: Uiso
authors.forename: J
authors.initials: J
authors.lastname: Ostermann
authors.forename: H
authors.initials: H
authors.lastname: Diefenthal
authors.forename: H J
authors.initials: HJ
authors.lastname: Shao
authors.forename: H Y
authors.initials: HY
authors.lastname: Chu
authors.forename: D M
authors.initials: DM
authors.lastname: Asmuth
authors.forename: N M
authors.initials: NM
authors.lastname: Thielman
authors.forename: J A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: J A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D007297:Inpatients; D007371:Interferon-gamma / Q000032:analysis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D013636:Tanzania; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D055815:Young Adult
chemical_list: D007371:Interferon-gamma