title: The dynamics of QuantiFERON-TB gold in-tube conversion and reversion in a cohort of South African adolescents.
abstract: BACKGROUND
  Interferon-γ release assays are used to diagnose tuberculosis infection. In developed countries, high rates of reversion following conversion have been described.
  
  
  OBJECTIVE
  To assess QuantiFERON TB Gold In-Tube test (QFT) conversion and reversion dynamics in a tuberculosis-endemic setting.
  
  
  METHODS
  Adolescents aged 12-18 years residing near Cape Town were recruited. Tuberculin skin tests (TSTs) and QFTs were performed at baseline and after 2 years of follow up. Half of the participants had TST and QFT performed at additional time points. Participants were observed for incident tuberculosis disease for up to 5 years.
  
  
  RESULTS
  Among 5,357 participants, 2,751 (51.4%) and 2,987 (55.8%) had positive QFT and TST results, respectively, at baseline. Annualized QFT and TST conversion risks were 14.0 and 13.0%, respectively, and reversion risks were 5.1 and 4.1%, respectively. Concordance was excellent for conversions (κ = 0.74), but poor for reversions (κ = 0.12). Among recent QFT converters, the magnitude of the QFT value was strongly inversely associated with risk of reversion (P < 0.0001). When longitudinal QFT data were analyzed in a cross-sectional manner, the annual risk of infection was 7.3%, whereas inclusion of reversions in the analysis showed that the actual risk of infection was 14.0%. Incident tuberculosis was 8-fold higher among QFT reverters than in participants with all negative QFT results (1.47 vs. 0.18 cases/100 person-years, P = 0.011).
  
  
  CONCLUSIONS
  In this tuberculosis-endemic setting, annual risk of infection was extremely high, whereas QFT and TST conversion concordance was higher and QFT reversion rates were lower than reported in low-burden settings.
authors.affiliation: 1 Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Andrews
authors.forename: Mark
authors.initials: M
authors.lastname: Hatherill
authors.forename: Hassan
authors.initials: H
authors.lastname: Mahomed
authors.forename: Willem A
authors.initials: WA
authors.lastname: Hanekom
authors.forename: Monica
authors.initials: M
authors.lastname: Campo
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Hawn
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Scriba
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011933:Reagent Kits, Diagnostic; D013019:South Africa; D014374:Tuberculin Test / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D011933:Reagent Kits, Diagnostic; D007371:Interferon-gamma
keywords: adolescents; epidemiology; interferon-γ release assays; tuberculin skin tests; tuberculosis