Evaluation of QuantiFERON-TB Gold In-Tube in human immunodeficiency virus infection and in patient candidates for anti-tumour necrosis factor-alpha treatment.
METHODS
Cross-sectional study at four out-patient clinics in a single referral centre in Italy.


OBJECTIVE
To evaluate the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) in human immunodeficiency virus (HIV) infected adults and in patients with immune-mediated inflammatory diseases (IMIDs) who are candidates for anti-tumour necrosis factor-alpha (TNF-alpha) treatment.


METHODS
A total of 402 immunocompromised patients were enrolled, including 207 HIV-infected individuals and 195 IMID patients scheduled for anti-TNF-alpha treatment. Tuberculin skin test (TST) and QFT-GIT were performed. For active tuberculosis (TB), test results were compared with microbiological, histopathological and clinical diagnoses.


RESULTS
In HIV-infected patients, the level of agreement between the tests was 68% and QFT-GIT sensitivity was 66% (95%CI 47-82). We found a large proportion of indeterminate QFT-GIT results (33.4%), which correlated with CD4 count < 200 cells/microl (P < 0.0001). The degree of agreement with TST was higher in IMID patients (81.6%). Factors associated with discordant positive TST and negative QFT-GIT results were bacille Calmette-Guérin vaccination (P = 0.0001), previous TB (P = 0.0001) and agricultural work (P = 0.0005).


CONCLUSIONS
The performance of QFT-GIT varies between different types of immunocompromised patients. Interferon-gamma release assays should not be used to confirm or rule out a diagnosis of active TB in HIV-infected adults. As there were no cases of active TB in the IMID subgroup, it was difficult to determine which test performs better in this population.
Sauzullo
I
I
Dipartimento di Malattie Infettive e Tropicali, Sapienza University, Rome, Italy.
Mengoni
F
F
Scrivo
R
R
Valesini
G
G
Potenza
C
C
Skroza
N
N
Marocco
R
R
Lichtner
M
M
Vullo
V
V
Mastroianni
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000276:immunology; D007371:Interferon-gamma / Q000032:analysis*; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000379:methods; D014376:Tuberculosis / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
D001500:BCG Vaccine; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma