title: QuantiFERON-TB Gold In-Tube Test for Tuberculosis Prevention in HIV-Infected Patients.
abstract: Optimal testing strategies for diagnosing latent tuberculosis infection and the administration of isoniazid preventive therapy (IPT) remain uncertain among human immunodeficiency virus (HIV)-infected patients. A 4-year prospective study was conducted among Thai HIV-infected patients who underwent simultaneous tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube Test (QFT-IT) at care entry. Based on baseline test results, patients were categorized into the following 4 groups: i) QFT-IT-positive, TST-reactive; ii) QFT-IT-positive, TST-non-reactive; iii) QFT-IT-negative, TST-reactive; and iv) QFT-IT-negative, TST-non-reactive. The QFT-IT-positive patients were offered 9-month IPT and were QFT-IT tested annually. Of the 150 enrolled patients, 8, 12, 16, and 114 patients were assigned to groups 1, 2, 3, and 4, respectively. Sixteen of 19 QFT-IT-positive patients (84%) completed IPT. The incidence of tuberculosis was significantly higher in patients who declined IPT than in those underwent treatment (11.11 vs. 0 case/100 patient-year; P ＜ 0.001). Among the 16 patients completing IPT, 11 (69%) and 2 (12%) had QFT-IT reversion at 1 and 2 years after IPT, respectively. The remaining 3 (19%) did not demonstrate any reversion, and their baseline interferon-γ (IFN-γ) levels were above 1.2 IU/mL. Initial QFT-IT-guided IPT was effective in preventing tuberculosis. Serial QFT-IT for evaluating IPT effectiveness had limitations because of delayed or lack of reversion, especially for patients with high baseline IFN-γ levels.
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University.
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.affiliation: National Institute of Health, Department of Medical Sciences, Ministry of Public Health.
authors.forename: Benjawan
authors.initials: B
authors.lastname: Phetsuksiri
authors.affiliation: National Institute of Health, Department of Medical Sciences, Ministry of Public Health.
authors.forename: Janisara
authors.initials: J
authors.lastname: Rudeeaneksin
authors.affiliation: National Institute of Health, Department of Medical Sciences, Ministry of Public Health.
authors.forename: Sopa
authors.initials: S
authors.lastname: Srisungngam
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University.
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D059425:Interferon-gamma Release Tests / Q000379:methods*; D007538:Isoniazid / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid
keywords: QuantiFERON-TB Gold In-Tube Test; Thailand; human immunodeficiency virus; isoniazid preventive therapy (IPT); latent tuberculosis infection