title: Tuberculin skin test and QuantiFERON-TB Gold In-tube Test for latent tuberculosis in Thai HIV-infected adults.
abstract: OBJECTIVE
  Limited data exist for the performance of QuantiFERON-TB Gold In-tube Test (QFT-IT) in comparison to tuberculin skin test (TST) for detecting latent tuberculosis (LTB) in patients with human immunodeficiency virus (HIV) infection from tuberculosis (TB)-endemic Asia-Pacific countries.
  
  
  METHODS
  A cohort study of Thai HIV-infected patients without history of TB or LTB treatment was conducted from March 2012 through March 2013. Each patient underwent simultaneous TST and QFT-IT.
  
  
  RESULTS
  Among the 150 enrolled subjects, the median age was 40 years (range 17-65), 53% were male, and the median CD4 count was 367 cells/μL (range 8-1290). Reactive TST and positive QFT-IT were 16% and 13%, respectively, with low concordance between tests (kappa = 0.26); correlation between TST reaction size and level of interferon-γ was moderate (r = 0.34). Independent factors associated with discordant results were long-term smoking (adjusted odds ratio (aOR) 5.74; P = 0.002) for TST-reactive, QFT-IT-negative subjects, and age greater than 52 years (aOR 5.56; P = 0.02) and female gender (aOR 4.40; P = 0.04) for TST non-reactive, QFT-IT-positive subjects. The level of agreement between both tests improved when using a TST cut-off of ≥ 10 mm (kappa = 0.39).
  
  
  CONCLUSIONS
  In our setting where QFT-IT is available but has limited use due to cost, TST with a cut-off of 10 mm for reactivity should be the initial LTB test. HIV-infected women and persons older than 52 years with non-reactive TST and long-term smokers with reactive TST may benefit from subsequent QFT-IT.
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Benjawan
authors.initials: B
authors.lastname: Phetsuksiri
authors.forename: Janisara
authors.initials: J
authors.lastname: Rudeeaneksin
authors.forename: Sopa
authors.initials: S
authors.lastname: Srisungngam
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mundy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012737:Sex Factors; D012907:Smoking; D013785:Thailand; D014374:Tuberculin Test; D055815:Young Adult
keywords: QuantiFERON-TB Gold In-tube Test; Thailand; human immunodeficiency virus; latent tuberculosis; tuberculin skin test