title: Comparison of two interferon-gamma release assays (QuantiFERON-TB Gold In-Tube and T-SPOT.TB) in testing for latent tuberculosis infection among HIV-infected adults.
abstract: There is currently no 'gold standard' for diagnosis of latent tuberculosis infection (LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are used for diagnosis; the latter have a higher sensitivity than tuberculin skin tests for diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence base exists for selection of IGRA methodology to identify LTBI among human immunodeficiency virus-infected patients in the UK. We prospectively evaluated two commercially available IGRA methods (QuantiFERON-TB Gold In Tube [QFG] and T-SPOT.TB) for testing LTBI among HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with 'smear-positive' pulmonary tuberculosis. Among the exposed patients median CD4 count was 550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result. Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence interval = 0.27-0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous culture-proven tuberculosis. No patient developed tuberculosis during 20 months of follow-up.
authors: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, UK.
authors: B
authors: B
authors: Sultan
authors: P
authors: P
authors: Benn
authors: T
authors: T
authors: Mahungu
authors: M
authors: M
authors: Young
authors: D
authors: D
authors: Mercey
authors: S
authors: S
authors: Morris-Jones
authors: R F
authors: RF
authors: Miller
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003428:Cross Infection; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis*; D059425:Interferon-gamma Release Tests / Q000379:methods*; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D007371:Interferon-gamma
keywords: AIDS; HIV; IGRA; Interferon-gamma release assays; Mycobacterium tuberculosis; latent tuberculosis infection; screening; tuberculin skin test
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