title: Predictors of discordant tuberculin skin test and QuantiFERON®-TB Gold In-Tube results in various high-risk groups.
abstract: METHODS
  Persons in whom targeted testing for latent tuberculosis infection (LTBI) is recommended in Seattle, Washington; Atlanta, Georgia; and central North Carolina, United States.
  
  
  OBJECTIVE
  To compare the performance of an interferon-gamma release assay (QuantiFERON®-TB Gold In-Tube [QFT-GIT]) with the tuberculin skin test (TST) among foreign-born, homeless, human immunodeficiency virus (HIV) infected and substance abuse persons tested for LTBI.
  
  
  METHODS
  A cross-sectional study requiring participants to have a blood test, a TST and data collected.
  
  
  RESULTS
  Of 1653 persons, 19.5% were TST-positive and 14.0% were QFT-GIT-positive. Overall concordance was moderate (kappa 0.53; 95%CI 0.47-0.58). Compared to concordant positive results, TST+/QFT-GIT- discordance was associated with HIV infection and sex, while TST-/QFT-GIT+ discordance was associated with HIV and inversely associated with foreign birth. Compared to concordant negative results, TST-/QFT-GIT+ discordance was associated with foreign birth and age ≥50 years, while TST+/QFT-GIT-discordance was associated with foreign birth, age 30-49 years, being Black and inversely associated with HIV. HIV infection was significantly associated with indeterminate QFT-GIT results.
  
  
  CONCLUSIONS
  QFT-GIT may be an improvement over the TST for diagnosing LTBI in foreign-born and older persons, and may be as useful as the TST in HIV-infected persons. The sensitivity of both tests may be low in HIV-infected persons.
authors: Westat, Rockville, MD, USA. cwa1@cdc.gov
authors: P
authors: P
authors: Weinfurter
authors: H M
authors: HM
authors: Blumberg
authors: G
authors: G
authors: Goldbaum
authors: R
authors: R
authors: Royce
authors: J
authors: J
authors: Pang
authors: J
authors: J
authors: Tapia
authors: J
authors: J
authors: Bethel
authors: G H
authors: GH
authors: Mazurek
authors: S
authors: S
authors: Toney
authors: R
authors: R
authors: Albalak
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D001500:BCG Vaccine / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000208:ethnology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D007118:Immunoassay / Q000706:statistics & numerical data*; D007371:Interferon-gamma / Q000378:metabolism*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000208:ethnology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012036:Refugees / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology / Q000382:microbiology*; D014374:Tuberculin Test / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
chemical_list: D001500:BCG Vaccine; D007371:Interferon-gamma