title: Diagnosis of latent tuberculosis infection before initiation of anti-tumor necrosis factor therapy using both tuberculin skin test and QuantiFERON-TB Gold In Tube assay.
abstract: BACKGROUND
  Reactivation of latent tuberculosis infection (LTBI) is an important complication in patients treated with tumor necrosis factor-alpha (TNF-α) blocking agents. However, the best method for LTBI detection before initiation of anti-TNF therapy remains to be determined.
  
  
  METHODS
  From January 2010 to August 2013, anti-TNF therapy was initiated in 426 patients with immune-mediated inflammatory diseases (IMIDs). Tuberculin skin test (TST) and Quantiferon-TB Gold In Tube (QFT-GIT) assay were performed before starting anti-TNF treatment. LTBI was defined as a positive TST (induration ≥ 10 mm) or as a positive QFT-GIT result. Patients were followed up until December 2013.
  
  
  RESULTS
  The positive TST and QFT-GIT rates were 22.3% (95/426) and 16.0% (68/426), respectively, yielding a total of 27.0% (115/426) of positive LTBI results. LTBI treatment was initiated in 25.1% (107/426) and was completed in 100% (107/107) of patients. During a median 294 days of follow-up, active TB occurred in 1.4% (6/426) of the patients with negative TST and QFT-GIT results at baseline.
  
  
  CONCLUSIONS
  The either test positive strategy, using both TST and QFT-GIT assay, is acceptable for LTBI screening before commencing anti-TNF therapy in patients with IMIDs.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Ho-Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Kyung-Wook
authors.initials: KW
authors.lastname: Jo
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Jung
authors.forename: Bin
authors.initials: B
authors.lastname: Yoo
authors.forename: Chang-Keun
authors.initials: CK
authors.lastname: Lee
authors.forename: Yong-Gil
authors.initials: YG
authors.lastname: Kim
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Kyung-Jo
authors.initials: KJ
authors.lastname: Kim
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Shim
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001327:Autoimmune Diseases / Q000188:drug therapy; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000379:methods*; D007538:Isoniazid / Q000008:administration & dosage; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage; D014374:Tuberculin Test / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha; D007538:Isoniazid; D012293:Rifampin
keywords: QuantiFERON-TB Gold In Tube; latent tuberculosis infection; tuberculin skin tests; tumor necrosis factor