Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis.
OBJECTIVE
To determine whether interferon-gamma release assays (IGRAs) improve the identification of HIV-infected individuals who could benefit from latent tuberculosis infection therapy.


METHODS
Systematic review and meta-analysis.


METHODS
We searched multiple databases through May 2010 for studies evaluating the performance of the newest commercial IGRAs (QuantiFERON-TB Gold In-Tube [QFT-GIT] and T-SPOT.TB [TSPOT]) in HIV-infected individuals. We assessed the quality of all studies included in the review, summarized results in prespecified subgroups using forest plots, and where appropriate, calculated pooled estimates using random effects models.


RESULTS
The search identified 37 studies that included 5736 HIV-infected individuals. In three longitudinal studies, the risk of active tuberculosis was higher in HIV-infected individuals with positive versus negative IGRA results. However, the risk difference was not statistically significant in the two studies that reported IGRA results according to manufacturer-recommended criteria. In persons with active tuberculosis (a surrogate reference standard for latent tuberculosis infection), pooled sensitivity estimates were heterogeneous but higher for TSPOT (72%; 95% confidence interval [CI], 62-81%) than for QFT-GIT (61%; 95% CI, 47-75%) in low-/middle-income countries. However, neither IGRA was consistently more sensitive than the tuberculin skin test in head-to-head comparisons. Although TSPOT appeared to be less affected by immunosuppression than QFT-GIT and the tuberculin skin test, overall, differences among the three tests were small or inconclusive.


CONCLUSIONS
Current evidence suggests that IGRAs perform similarly to the tuberculin skin test at identifying HIV-infected individuals with latent tuberculosis infection. Given that both tests have modest predictive value and suboptimal sensitivity, the decision to use either test should be based on country guidelines and resource and logistic considerations.
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
Adithya
A
Cattamanchi
Rachel
R
Smith
Karen R
KR
Steingart
John Z
JZ
Metcalfe
Anand
A
Date
Courtney
C
Coleman
Barbara J
BJ
Marston
Laurence
L
Huang
Philip C
PC
Hopewell
Madhukar
M
Pai
D019411:Clinical Laboratory Techniques / Q000379:methods*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007371:Interferon-gamma / Q000378:metabolism; D055985:Latent Tuberculosis / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014374:Tuberculin Test
D007371:Interferon-gamma
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