1
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Diagnostic accuracy of the interferon-gamma release assay in acquired immunodeficiency syndrome patients with suspected tuberculosis infection: a meta-analysis. Infection 2022; 50:597-606. [PMID: 35249210 PMCID: PMC9151521 DOI: 10.1007/s15010-022-01789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/22/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose
The diagnostic accuracy of the interferon-gamma release assay (IGRA) in immunosuppressed patients remains unclear.
Methods
A systematic review and meta-analysis were performed for diagnostic test accuracy of IGRA in tuberculosis (TB) infection among people living with HIV (PLWHIV). Summary estimates of sensitivity and specificity were calculated using both univariate and bivariate models.
Results
The meta-analysis included 45 of the 1,242 first-screened articles. The total number of PLWHIV was 6,525; 3,467 had TB disease, including 806 cases of LTBI and 2,661 cases of active TB. The overall diagnostic odds ratio (DOR) of IGRA in the diagnosis of TB disease was 10.0 (95% confidence interval (CI) 5.59, 25.07), with an area under the curve (AUC) of 0.729. The DOR was better for QFT (14.2 (95%CI 4.359, 46.463)) than T-SPOT (10.0 (95%CI 3.866 26.033)). The sensitivity and specificity of QFT and T-SPOT were 0.663 (95%CI 0.471, 0.813), 0.867 (95%CI 0.683 0.942), and 0.604 (95%CI 0.481, 0.715), 0.862 (95%CI 0.654, 0.954), respectively, in the bivariate model. The sensitivity of IGRA in the diagnosis of LTBI was 0.64 (95%CI 0.61, 0.66).
Conclusion
IGRA was useful in the diagnostic of TB disease in PLWHIV, and QFT showed a better tendency of DOR than T-SPOT. IGRA showed a limited effect to rule out LTBI in PLWHIV.
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2
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Guo Q, Zhang J, Li G, Liu S, Xiao G, Bi J, Li F, Zhang S, Ou M, He X, Zeng C, Liu L, Zhang G. Elevated antigen-specific IFN-γ responses in bronchoalveolar lavage fluid impervious to clinical comorbidities improve the pulmonary tuberculosis diagnosis. Tuberculosis (Edinb) 2020; 122:101942. [PMID: 32501262 DOI: 10.1016/j.tube.2020.101942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/28/2022]
Abstract
The extremely slow growth rate of Mycobacterium tuberculosis (Mtb) challenges traditional methods for tuberculosis (TB) diagnosis. Here, we assessed the efficacy of a previously developed Mtb antigen-specific gamma interferon (IFN-γ) enzyme-linked immunospot (ELISPOT) performed on bronchoalveolar lavage fluid (BALF) from a cohort of 414 patients including 333 PTB patients (202/333 were sputum culture positive) for the diagnosis of PTB. We could confirm that antigen-specific IFN-γ-producing CD4+ T cells were concentrated significantly in BALF mononuclear cells (BALMC) compared with that in peripheral blood mononuclear cells (PBMC) assayed in parallel, but not those of CD8+ T cells both in sputum culture-negative and positive PTB. The magnitude of IFN-γ responses in the BALF was associated with bacterial load, and 9/202 of PTB with endobronchial TB (EBTB) were slightly reduced by the anti-TB treatment. Moreover, antigen-specific IFN-γ ELISPOT performed on BALMC showed higher sensitivity than PBMC ELISPOT. In addition, the differences of the BALMC ELISPOT between PTB and PTB with diabetes were not found, whereas PBMC IFN-γ responses were decreased in PTB with diabetes. Combined with the microbiological detection in BALF, such as microscopy and culture, the BALMC ELISPOT offers the opportunity for the more accurate diagnosis of PTB, especially those with clinical comorbidities.
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Affiliation(s)
- Qinglong Guo
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Juanjuan Zhang
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Guanqiang Li
- Department of Laboratory Medicine, Shenzhen Longgang People's Hospital, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Shuyan Liu
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Guohui Xiao
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Jing Bi
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Fang Li
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Su Zhang
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Min Ou
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Xing He
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Changchun Zeng
- Department of Laboratory Medicine, Shenzhen Longhua District Central Hospital, Guangdong Medical University, Shenzhen, 518110, China
| | - Lei Liu
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Guoliang Zhang
- National Clinical Research Center for Infectious Diseases, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China; Department of Laboratory Medicine, Shenzhen Longhua District Central Hospital, Guangdong Medical University, Shenzhen, 518110, China.
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3
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Murray LW, Satti I, Meyerowitz J, Jones M, Willberg CB, Ussher JE, Goedhals D, Hurst J, Phillips RE, McShane H, Vuuren CV, Frater J. Human Immunodeficiency Virus Infection Impairs Th1 and Th17 Mycobacterium tuberculosis-Specific T-Cell Responses. J Infect Dis 2019; 217:1782-1792. [PMID: 29546381 DOI: 10.1093/infdis/jiy052] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background Human immunodeficiency virus (HIV)-infected individuals have a higher risk of developing active tuberculosis (TB) than HIV-uninfected individuals, but the mechanisms underpinning this are unclear. We hypothesized that depletion of specific components of Mycobacterium tuberculosis (Mtb)-specific CD4+ and CD8+ T-cell responses contributed to this increased risk. Methods Mtb-specific T-cell responses in 147 HIV-infected and 44 HIV-uninfected control subjects in a TB-endemic setting in Bloemfontein, South Africa, were evaluated. Using a whole-blood flow cytometry assay, we measured expression of interferon gamma, tumor necrosis factor alpha, interleukin 2, and interleukin 17 in CD4+ and CD8+ T cells in response to Mtb antigens (PPD, ESAT-6/CFP-10 [EC], and DosR regulon-encoded α-crystallin [Rv2031c]). Results Fewer HIV-infected individuals had detectable CD4+ and CD8+ T-cell responses to PPD and Rv2031c than HIV-uninfected subjects. Mtb-specific T cells showed distinct patterns of cytokine expression comprising both Th1 (CD4 and CD8) and Th17 (CD4) cytokines, the latter at highest frequency for Rv2031c. Th17 antigen-specific responses to all antigens tested were specifically impaired in HIV-infected individuals. Conclusions HIV-associated impairment of CD4+ and CD8+Mtb-specific T-cell responses is antigen specific, particularly impacting responses to PPD and Rv2031c. Preferential depletion of Th17 cytokine-expressing CD4+ T cells suggests this T-cell subset may be key to TB susceptibility in HIV-infected individuals.
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Affiliation(s)
- Lyle W Murray
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Iman Satti
- Jenner Institute, University of Oxford, United Kingdom
| | - Jodi Meyerowitz
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Matthew Jones
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Christian B Willberg
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Oxford National Institute of Health Research Biomedical Research Centre, United Kingdom
| | - James E Ussher
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Dominique Goedhals
- Department of Medical Microbiology and Virology, National Health Laboratory Service/University of the Free State, Bloemfontein, South Africa
| | - Jacob Hurst
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Oxford Martin School, Oxford, United Kingdom
| | - Rodney E Phillips
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Oxford Martin School, Oxford, United Kingdom
| | - Helen McShane
- Jenner Institute, University of Oxford, United Kingdom
| | - Cloete van Vuuren
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - John Frater
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Oxford National Institute of Health Research Biomedical Research Centre, United Kingdom.,Oxford Martin School, Oxford, United Kingdom
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4
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[Interferon gamma release assay tests and HIV infection]. Rev Mal Respir 2018; 35:883-886. [PMID: 30224209 DOI: 10.1016/j.rmr.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/21/2018] [Indexed: 11/21/2022]
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5
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McCormick-Baw C, Hollaway R, Cavuoti D. Diagnosis of Latent Mycobacterium tuberculosis Infection in the Era of Interferon Gamma Release Assays. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.clinmicnews.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Lin AWC, Lau SKP, Woo PCY. Screening and treatment of latent tuberculosis infection among HIV-infected patients in resource-rich settings. Expert Rev Anti Infect Ther 2016; 14:489-500. [PMID: 26999724 DOI: 10.1586/14787210.2016.1168693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current international guidelines recommend screening and treatment of latent tuberculosis (TB) infection in HIV-infected patients in all settings. The main factors affecting the risk of TB in HIV-infected patients include the level of immunosuppression, coverage of antiretroviral therapy and local TB burden. In resource-rich settings where antiretroviral therapy is more accessible and HIV-infected patients are expected to be diagnosed at an earlier stage, local TB burden remains a key factor on their risk of TB. This article reviewed the epidemiology of latent TB infection among the adult HIV-infected patients, and the use and benefit of screening and treatment of latent TB infection in resource-rich settings in the past decade. While such practice should be continued in countries with medium or high TB burden, targeted screening and treatment only for HIV-infected patients with additional risk factors for TB might be a more practical option in resource-rich countries with low TB burden.
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Affiliation(s)
- Ada W C Lin
- a Department of Microbiology , The University of Hong Kong , Hong Kong , China
| | - Susanna K P Lau
- a Department of Microbiology , The University of Hong Kong , Hong Kong , China.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Hong Kong , China.,c Research Centre of Infection and Immunology , The University of Hong Kong , Hong Kong , China.,d Carol Yu Centre for Infection , The University of Hong Kong , Hong Kong , China
| | - Patrick C Y Woo
- a Department of Microbiology , The University of Hong Kong , Hong Kong , China.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Hong Kong , China.,c Research Centre of Infection and Immunology , The University of Hong Kong , Hong Kong , China.,d Carol Yu Centre for Infection , The University of Hong Kong , Hong Kong , China
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7
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Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, Lewinsohn DA, Loeffler AM, Mazurek GH, O'Brien RJ, Pai M, Richeldi L, Salfinger M, Shinnick TM, Sterling TR, Warshauer DM, Woods GL. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2016; 64:e1-e33. [PMID: 27932390 DOI: 10.1093/cid/ciw694] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. METHODS A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. CONCLUSIONS These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.
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Affiliation(s)
| | | | - Philip A LoBue
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L Cohn
- Denver Public Health Department, Denver, Colorado
| | - Charles L Daley
- National Jewish Health and the University of Colorado Denver, and
| | - Ed Desmond
- California Department of Public Health, Richmond
| | | | | | - Ann M Loeffler
- Francis J. Curry International TB Center, San Francisco, California
| | | | | | - Madhukar Pai
- McGill University and McGill International TB Centre, Montreal, Canada
| | | | | | | | - Timothy R Sterling
- Vanderbilt University School of Medicine, Vanderbilt Institute for Global Health, Nashville, Tennessee
| | | | - Gail L Woods
- University of Arkansas for Medical Sciences, Little Rock
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8
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Dai Q, Lu W, Hou W. QFT-IT for diagnosing and screening TB infection in HIV patients: CD4 cells count as an important influential factor. Int J STD AIDS 2016; 27:701. [PMID: 27278449 DOI: 10.1177/0956462415606253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Qinghai Dai
- Tianjin Second People's Hospital and Tianjin Institute of Hepatology, Tianjin, People's Republic of China
| | - Wei Lu
- Tianjin Second People's Hospital and Tianjin Institute of Hepatology, Tianjin, People's Republic of China
| | - Wei Hou
- Tianjin Second People's Hospital and Tianjin Institute of Hepatology, Tianjin, People's Republic of China
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9
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Lu P, Chen X, Zhu LM, Yang HT. Interferon-Gamma Release Assays for the Diagnosis of Tuberculosis: A Systematic Review and Meta-analysis. Lung 2016; 194:447-58. [PMID: 27039307 DOI: 10.1007/s00408-016-9872-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/24/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE We conducted a systematic review and meta-analysis to compare the accuracy of the interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for the diagnosis of Mycobacterium tuberculosis infection. METHODS We systematically searched PubMed, Embase, Cochrane library, and Web of Science databases for relevant published studies in recent decades and calculated pooled estimated sensitivities, specificities, DOR, and SROC curve of the QFT-IT, T-SPOT and TST. Random-effects models were used to assess estimates from studies with significant heterogeneity. Moreover, area under the curve was used to evaluate the accuracy of the tests. RESULTS Overall, 9 studies for QFT-IT, 12 studies for T-SPOT, and 16 studies for TST involving 3586 participants were included in this analysis. We found that sensitivities of the QFT-IT, T-SPOT, and TST were respectively 0.842 (95 % CI 0.811-0.870), 0.840 (95 % CI 0.814-0.864), and 0.665 (CI 0.635-0.693); specificities were respectively 0.745 (95 % CI 0.715-0.775), 0.658 (95 % CI 0.621-0.693), and 0.633 (CI 0.605-0.661); positive likelihood ratios were respectively 3.652 (95 % CI 2.180-6.117), 2.196 (95 % CI 1.727-2.794), and 1.825 (95 % CI 1.351-2.464); negative likelihood ratios were respectively 0.212 (95 % CI 0.109-0.414), 0.246 (95 % CI 0.161-0.377), and 0.556 (95 % CI 0.385-0.804); the SROC curves were 19.205, 10.397, and 3.810. CONCLUSIONS The two IGRAs showed better performance than TST for the diagnosis of the tuberculosis. However, neither of them showed stability in the diagnosis of TB.
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Affiliation(s)
- Peng Lu
- School of Public Health, Nanjing Medical University, Longmiandadao 101, Nanjing, 211166, China.,Department of Chronic Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention Affiliated to Nanjing Medical University, Jiangsulu 172, Nanjing, 210009, China
| | - Xiu Chen
- The Fourth Clinical School of Nanjing Medical University, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Baiziting 42, Nanjing, 210009, China
| | - Li-Mei Zhu
- Department of Chronic Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention Affiliated to Nanjing Medical University, Jiangsulu 172, Nanjing, 210009, China
| | - Hai-Tao Yang
- Jiangsu Institute of Parasitic Diseases, Yangxiang 117, Wuxi, 214064, China. .,Nanjing Medical University, Longmiandadao 101, Nanjing, 211166, China.
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10
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Santin M, García-García JM, Domínguez J. Guidelines for the use of interferon-γ release assays in the diagnosis of tuberculosis infection. Enferm Infecc Microbiol Clin 2016; 34:303.e1-13. [PMID: 26917222 DOI: 10.1016/j.eimc.2015.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in low-prevalence countries. However, there is no consensus on their application. The objective of this study was to develop guidelines for the use of interferon-gamma release assays in specific clinical scenarios in Spain. METHODS A panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, formulated the clinical questions and outcomes of interest. They conducted a systematic literature search, summarized the evidence and rated its quality, and prepared the recommendations following the GRADE (Grading of Recommendations of Assessment Development and Evaluations) methodology. RESULTS The panel prepared recommendations on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in the contact-tracing study (both adults and children), health care workers, immunosuppressed patients (patients infected with human immunodeficiency virus, patients with chronic immunomediated inflammatory diseases due to start biological therapy and patients requiring organ transplant) and for the diagnosis of active tuberculosis. Most recommendations were weak, mainly due to the lack of good quality evidence to balance the clinical benefits and disadvantages of the interferon-gamma release assays as compared with the tuberculin skin test. CONCLUSION This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at risk of tuberculosis or with suspicion of active disease. The guidelines will be applicable in specialist and primary care and in public health settings.
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Affiliation(s)
- Miguel Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | | | - José Domínguez
- Service of Microbiology, Research Institute Trias i Pujol, Hospital Gremans Trias i Pujol, Barcelona, Spain; Department of Genetics and Microbiology, Universidad Autónoma de Barcelona, Barcelona, Spain; CIBER Respiratory Diseases, Madrid, Spain.
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11
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Khazraiyan H, Liaei ZA, Koochak HE, Ardalan FA, Ahmadinejad Z, Soltani A. Utility of QuantiFERON-TB Gold In-Tube Test in the Diagnosis of Latent TB in HIV-Positive Patients in a Medium-TB Burden Country. J Int Assoc Provid AIDS Care 2015; 15:101-6. [PMID: 26514628 DOI: 10.1177/2325957415614645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The authors aimed to compare TST with QuantiFERON-TB Gold In-Tube (QFT) for detecting latent tuberculosis infection (LTBI) in HIV-infected patients in Iran as a TB-medium endemic country. METHODS In a cross-sectional design,130 HIV-positive patients in HIV clinic of Tehran University were studied. Patients screened for LTBI with QFT and TST simultaneously. Concordance between 2 tests results and variables associated with tests discordance were assessed. RESULTS Positive results found in 24.6% for TST and 7.7% for QFT. Overall agreement between them was 73.85% (Kappa = 0.083). History of imprisonment was associated with more positive TST (P = 0.014) and QFT (P = 0.01). Patients with intravenous drug use (IDU) history had significant discordant results (0.018). CONCLUSION The authors recommend QFT for all negative cases of TST in HIV-positive patients especially who had history of IDU.
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Affiliation(s)
- Hamideh Khazraiyan
- Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Abdi Liaei
- Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Emadi Koochak
- Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Azmoudeh Ardalan
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Soltani
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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12
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Mothé BR, Lindestam Arlehamn CS, Dow C, Dillon MBC, Wiseman RW, Bohn P, Karl J, Golden NA, Gilpin T, Foreman TW, Rodgers MA, Mehra S, Scriba TJ, Flynn JL, Kaushal D, O'Connor DH, Sette A. The TB-specific CD4(+) T cell immune repertoire in both cynomolgus and rhesus macaques largely overlap with humans. Tuberculosis (Edinb) 2015; 95:722-735. [PMID: 26526557 DOI: 10.1016/j.tube.2015.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/23/2015] [Accepted: 07/26/2015] [Indexed: 01/05/2023]
Abstract
Non-human primate (NHP) models of tuberculosis (TB) immunity and pathogenesis, especially rhesus and cynomolgus macaques, are particularly attractive because of the high similarity of the human and macaque immune systems. However, little is known about the MHC class II epitopes recognized in macaques, thus hindering the establishment of immune correlates of immunopathology and protective vaccination. We characterized immune responses in rhesus macaques vaccinated against and/or infected with Mycobacterium tuberculosis (Mtb), to a panel of antigens currently in human vaccine trials. We defined 54 new immunodominant CD4(+) T cell epitopes, and noted that antigens immunodominant in humans are also immunodominant in rhesus macaques, including Rv3875 (ESAT-6) and Rv3874 (CFP10). Pedigree and inferred restriction analysis demonstrated that this phenomenon was not due to common ancestry or inbreeding, but rather presentation by common alleles, as well as, promiscuous binding. Experiments using a second cohort of rhesus macaques demonstrated that a pool of epitopes defined in the previous experiments can be used to detect T cell responses in over 75% of individual monkeys. Additionally, 100% of cynomolgus macaques, irrespective of their latent or active TB status, responded to rhesus and human defined epitope pools. Thus, these findings reveal an unexpected general repertoire overlap between MHC class II epitopes recognized in both species of macaques and in humans, showing that epitope pools defined in humans can also be used to characterize macaque responses, despite differences in species and antigen exposure. The results have general implications for the evaluation of new vaccines and diagnostics in NHPs, and immediate applicability in the setting of macaque models of TB.
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Affiliation(s)
- Bianca R Mothé
- Department of Biology, CSUSM, San Marcos, CA 92096, USA; La Jolla Institute for Allergy & Immunology, La Jolla, CA 92037, USA.
| | | | - Courtney Dow
- Department of Biology, CSUSM, San Marcos, CA 92096, USA
| | - Myles B C Dillon
- La Jolla Institute for Allergy & Immunology, La Jolla, CA 92037, USA
| | - Roger W Wiseman
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Patrick Bohn
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Julie Karl
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Nadia A Golden
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Trey Gilpin
- Department of Biology, CSUSM, San Marcos, CA 92096, USA
| | - Taylor W Foreman
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Mark A Rodgers
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15216, USA
| | - Smriti Mehra
- Tulane National Primate Research Center, Covington, LA 70433, USA; Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University Baton Rouge, LA 70803, USA
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Department of Pediatrics and Child Health, University of Cape Town, Cape Town 7925, South Africa
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15216, USA
| | - Deepak Kaushal
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - David H O'Connor
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Alessandro Sette
- La Jolla Institute for Allergy & Immunology, La Jolla, CA 92037, USA
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13
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Capocci S, Smith C, Morris S, Bhagani S, Cropley I, Abubakar I, Johnson M, Lipman M. Decreasing cost effectiveness of testing for latent TB in HIV in a low TB incidence area. Eur Respir J 2015; 46:165-74. [PMID: 25882810 DOI: 10.1183/09031936.00067114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 01/07/2015] [Indexed: 11/05/2022]
Abstract
Testing for latent tuberculosis infection (LTBI) in HIV-infected persons in low tuberculosis (TB) incidence areas is often recommended. Using contemporary, clinical data, we report the yield and cost-effectiveness of testing all HIV attendees, two current UK strategies and no LTBI testing. Economic modelling was performed utilising 10-year follow up data from a large HIV clinical cohort. Outcomes were numbers of cases of active TB and incremental cost per quality-adjusted life year (QALY) gained. Between 2000 and 2010, 256 people were treated for TB/HIV co-infection. 72 (28%) occurred ≥3 months after HIV diagnosis and may have been prevented by LTBI testing. Between 2000 and 2005, the incremental cost per QALY gained for the British HIV Association (BHIVA) and UK National Institute of Care Excellence (NICE) strategies, and testing all clinic attendees was €6270, €6998 and €33,473, respectively. These rose to €9332, €32,564 and €74,067, respectively, between 2005 and 2010. Probabilistic sensitivity analysis suggested that at a threshold of €24,000 per additional QALY, the most cost-effective strategies would be NICE or testing all in 2000-2005 and BHIVA during 2005-2010. Both UK testing regimens missed cases but are cost-effective compared with no testing. Using recent data, they all became more expensive, suggesting that alternative or more targeted TB testing strategies must be considered.
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Affiliation(s)
- Santino Capocci
- Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Colette Smith
- Department of Infection and Population Health, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Sanjay Bhagani
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Cropley
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Ibrahim Abubakar
- Research Department of Infection and Population Health, University College London, London, UK Medical Research Council Clinical Trials Unit, London, UK
| | - Margaret Johnson
- Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Marc Lipman
- Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK Division of Medicine, University College London, London, UK
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Siddiqui S, Sarro Y, Diarra B, Diallo H, Guindo O, Dabitao D, Tall M, Hammond A, Kassambara H, Goita D, Dembele P, Traore B, Hengel R, Nason M, Warfield J, Washington J, Polis M, Diallo S, Dao S, Koita O, Lane HC, Catalfamo M, Tounkara A. Tuberculosis specific responses following therapy for TB: Impact of HIV co-infection. Clin Immunol 2015; 159:1-12. [PMID: 25889622 DOI: 10.1016/j.clim.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/24/2015] [Accepted: 04/01/2015] [Indexed: 02/06/2023]
Abstract
Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.
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Affiliation(s)
- S Siddiqui
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA.
| | - Y Sarro
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - B Diarra
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - H Diallo
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - O Guindo
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - D Dabitao
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - M Tall
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - A Hammond
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - H Kassambara
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - D Goita
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - P Dembele
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - B Traore
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - R Hengel
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - M Nason
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - J Warfield
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - J Washington
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - M Polis
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - S Diallo
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - S Dao
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - O Koita
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - H C Lane
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - M Catalfamo
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
| | - A Tounkara
- Collaborative Clinical Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rm 1167, Bldg. 6700B, Rockledge Drive, Bethesda, MD 20892, USA
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Cai R, Chen J, Guan L, Sun M, Sun Y, Shen Y, Zhang R, Liu L, Lu H. Relationship between T-SPOT.TB responses and numbers of circulating CD4+ T-cells in HIV infected patients with active tuberculosis. Biosci Trends 2015; 8:163-8. [PMID: 25030851 DOI: 10.5582/bst.2014.01032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study sought to evaluate the performance of the T-SPOT.TB assay for the diagnosis of active tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients. One hundred confirmed HIV-infected patients with active TB and known T-SPOT.TB and CD4+ T-cell counts were enrolled in this clinical retrospective study. We found that patients with lower CD4+ T-cell counts (11-50 cells/μL) had the lowest T-SPOT.TB positive rates (50%), and patients with higher CD4+ T-cell counts (50-100 cells/μL) had the highest T-SPOT.TB positive rates (75%). However, there were no significant differences between the T-SPOT.TB positive rates of patients with different CD4+ T-cell counts (< 10, 11-50, 51-100 and > 100 cells/μL) (χ(2) = 3.7747, p = 0.287). The patients with positive TB culture results had significantly higher T-SPOT.TB positive rates (78.9%) than patients that were culture-negative (44.3%) (χ(2) = 12.8303, p < 0.001). Other variables, including gender, age, TB disease classification, HIV RNA level, and highly reactive antiretroviral therapy (HAART), had no significant effects on T-SPOT.TB positive rates. The number of spot-forming cells (SFCs) reactive with ESAT-6, CFP-10 and ESAT-6/CFP-10-specific T cells detected by T-SPOT.TB were positively is strongly related to the degree of immunodeficiency, while the T-SPOT.TB positive rates are less dependent on the level of CD4+ T-cell depletion in HIV infection and active TB.
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Affiliation(s)
- Rentian Cai
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
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Pullar ND, Steinum H, Bruun JN, Dyrhol-Riise AM. HIV patients with latent tuberculosis living in a low-endemic country do not develop active disease during a 2 year follow-up; a Norwegian prospective multicenter study. BMC Infect Dis 2014; 14:667. [PMID: 25515915 PMCID: PMC4273430 DOI: 10.1186/s12879-014-0667-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interferon-γ release assays (IGRA) serve as immunodiagnostics of tuberculosis (TB) infection to identify individuals with latent TB infection (LTBI) eligible for preventive anti-TB therapy. In this longitudinal study of HIV-infected LTBI patients we have observed for possible progression to active TB as well as evaluated repeated IGRA testing in a TB low-endemic setting. METHODS QuantiFERON TB-Gold In-tube® assay (QFT), TB-SPOT.TB® (TSPOT) and tuberculin skin test (TST) were performed on 298 HIV-patients recruited from seven out-patient clinics in Norway. Patients with active TB, LTBI and negative IGRA were followed with repeat QFTs and clinical evaluation over a period of 24 months. RESULTS Seven HIV-patients (median CD4 count 270; IQR 50-340) were diagnosed with active TB at inclusion, all IGRA positive. Sixty-four (21%) HIV-patients (median CD4 count 471; IQR 342-638) were diagnosed with LTBI and of these 39 (61%) received TB preventive treatment. Neither treated nor untreated HIV-infected LTBI patients developed active TB during the 24 months. At baseline, the median interferon-γ (INF-γ) level measured by QFT was 3.48 IU/ml (IQR 0.94-8.91 IU/ml) for treated LTBI compared to 1.13 IU/ml (IQR 0.47-4.25 IU/ml) for untreated LTBI patients (p = 0.029). The QFT reversion rates were 75% for active TB, 23% for treated LTBI and 44% for untreated LTBI, whereas the conversion rate for the non-TB group was 7% despite no new TB exposure. There was no significant difference in the trend of INF-γ levels over time between treated and untreated LTBI patients. CONCLUSION The prevalence of LTBI is high among HIV-patients, but the risk of developing active TB seems to be low in patients with high CD4 counts in this TB low-endemic setting. In several patients, especially with baseline IFN-γ levels close to cut-offs, the QFT tests reverted to negative independent of preventive anti-TB treatment indicating possibly false positive tests. This highlights the importance of defining reliable cut-offs for immunodiagnostic tests and deferring preventive therapy in selected patients. Randomized studies with longer follow-up time are needed to identify HIV-patients that would benefit from LTBI treatment in a TB low-endemic setting.
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Affiliation(s)
- Nadine Durema Pullar
- Department of Internal Medicine, Section for Infectious Diseases, University Hospital of Northern Norway, N-9038, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway.
| | - Harald Steinum
- Department of Infectious Diseases, Trondheim University Hospital, N-7004, Trondheim, Norway.
| | - Johan Nikolai Bruun
- Department of Internal Medicine, Section for Infectious Diseases, University Hospital of Northern Norway, N-9038, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway.
| | - Anne Ma Dyrhol-Riise
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, N-5021, Bergen, Norway. .,Present address: Department of Infectious Diseases, Oslo University Hospital (Ullevål), pb 4956 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, 0316, Oslo, Norway.
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Latent Tuberculosis screening using interferon-gamma release assays in an Australian HIV-infected cohort: is routine testing worthwhile? J Acquir Immune Defic Syndr 2014; 66:48-54. [PMID: 24457631 DOI: 10.1097/qai.0000000000000109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data from high-income countries on the performance of interferon-gamma release assays in screening for latent tuberculosis infection (LTBI). We analyzed the routine application of the Quantiferon-TB Gold (QFT-G) assay to detect and predict latent and active TB among HIV-infected patients in Australia. METHODS A retrospective cohort study included all HIV-infected patients attending the Melbourne Sexual Health Service between March 2003 and February 2011 who were screened for LTBI using QFT-G. Clinical data were analyzed in multivariable models to determine predictors for QFT-G positivity using logistic regression and active TB development using Cox proportional hazards. RESULTS Nine hundred seventeen HIV-infected patients had ≥1 QFT-G performed, of whom 884 (96.4%) were negative, 29 (3.2%) positive, and 4 (0.4%) indeterminate. The mean age was 40.9 years and 88% were male, with median follow-up of 26.4 (interquartile range 15.4-30.7) months. Five hundred fifty (63%) were Australian born, whereas 198 (23%) were born in Asia or Africa. QFT-G was positive in 2.0% of Australian-born, 5.3% of overseas-born [odds ratio: 2.6, 95% confidence interval (CI): 1.2 to 5.6, P = 0.017], and 12.7% of African-born patients (odds ratio 7.1, 95% CI: 2.9 to 17.3, P < 0.001). Two cases of culture-positive TB occurred after QFT-G screening in 3.4% of QFT-G-positive and 0.1% of QFT-G-negative patients (adjusted hazard ratio: 42.4, 95% CI: 2.2 to 827, P = 0.013), a rate of 111 (95% CI: 27.8 to 445) per 100,000 person-years. CONCLUSIONS In this context, QFT-G has a high negative predictive (99.9%) value with few indeterminate results. A risk stratification approach to LTBI screening, where HIV-infected patients with epidemiological risk factors for TB infection undergo QFT-G testing, might be clinically appropriate and potentially cost effective in similar settings.
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18
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Souza JMO, Evangelista MDSN, Trajman A. Added value of QuantiFERON TB-gold in-tube for detecting latent tuberculosis infection among persons living with HIV/AIDS. BIOMED RESEARCH INTERNATIONAL 2014; 2014:294963. [PMID: 24991546 PMCID: PMC4058839 DOI: 10.1155/2014/294963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/13/2014] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. METHODS Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. RESULTS Median CD4-cell count was 477.5 cells/mm(3); 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%-9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%-2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%-4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%-3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). CONCLUSIONS The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.
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Affiliation(s)
- Josiane Maria Oliveira Souza
- University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil
- SHA, Conjunto 5 chácara 47, Quadra D, Arniqueiras, 71995-297 Taguatinga, DF, Brazil
| | - Maria do Socorro Nantua Evangelista
- University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil
- Catholic University of Brasilia (UCB), Campus I, QS 07 Lote 01 EPCT, Águas Claras, 71966-700 Taguatinga, DF, Brazil
| | - Anete Trajman
- Federal University of Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowsky s/n°, Ilha do Fundão Prédio do Hospital Universitário Clementino Fraga Filho, 11° andar Bloco F, Sala 4, 21941-590 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, 3650 St. Urbain Street, Montreal, QC, Canada H2X 2P4
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Markova R, Todorova Y, Drenska R, Elenkov I, Yankova M, Stefanova D. Usefulness of Interferon-Gamma Release Assays in the Diagnosis of Tuberculosis Infection in HIV-Infected Patients in Bulgaria. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.1080/13102818.2009.10817622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Salgado E, Gómez-Reino JJ. The risk of tuberculosis in patients treated with TNF antagonists. Expert Rev Clin Immunol 2014; 7:329-40. [DOI: 10.1586/eci.11.6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Al-Zamel FA. Detection and diagnosis ofMycobacterium tuberculosis. Expert Rev Anti Infect Ther 2014; 7:1099-108. [DOI: 10.1586/eri.09.92] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chegou NN, Hoek KGP, Kriel M, Warren RM, Victor TC, Walzl G. Tuberculosis assays: past, present and future. Expert Rev Anti Infect Ther 2014; 9:457-69. [DOI: 10.1586/eri.11.23] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Richeldi L, Losi M, Cerri S, Casali L, Fabbri LM, Ferrara G. Using ELISpot technology to improve the diagnosis of tuberculosis infection: from the bench to the T-SPOT.TBassay. Expert Rev Respir Med 2014; 2:253-60. [DOI: 10.1586/17476348.2.2.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Domínguez J, Latorre I, Altet N, Mateo L, De Souza-Galvão M, Ruiz-Manzano J, Ausina V. IFN-γ-release assays to diagnose TB infection in the immunocompromised individual. Expert Rev Respir Med 2014; 3:309-27. [DOI: 10.1586/ers.09.20] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Thillai M, Pollock K, Pareek M, Lalvani A. Interferon-gamma release assays for tuberculosis: current and future applications. Expert Rev Respir Med 2013; 8:67-78. [DOI: 10.1586/17476348.2014.852471] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Chkhartishvili N, Kempker RR, Dvali N, Abashidze L, Sharavdze L, Gabunia P, Blumberg HM, del Rio C, Tsertsvadze T. Poor agreement between interferon-gamma release assays and the tuberculin skin test among HIV-infected individuals in the country of Georgia. BMC Infect Dis 2013; 13:513. [PMID: 24176032 PMCID: PMC3817813 DOI: 10.1186/1471-2334-13-513] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improved tests to diagnose latent TB infection (LTBI) are needed. We sought to evaluate the performance of two commercially available interferon-gamma release assays (IGRAs) compared to the tuberculin skin test (TST) for the diagnosis of LTBI and to identify risk factors for LTBI among HIV-infected individuals in Georgia, a country with high rates of TB. METHODS HIV-patients were enrolled from the National AIDS Center in Tbilisi, Georgia. After providing informed consent, each participant completed a questionnaire, had blood drawn for QuantiFERON-TB Gold in-Tube (QFT-GIT) and T-SPOT.TB testing and had a TST placed. The TST was read at 48-72 hrs with ≥ 5 mm induration considered positive. RESULTS Between 2009-2011, 240 HIV-infected persons (66% male) with a median age of 38 years and a median CD4 count of 255 cells/μl (IQR: 124-412) had diagnostic testing for LTBI performed. 94% had visible evidence of a BCG scar. The TST was positive in 41 (17%) patients; QFT-GIT in 70 (29%); and T-SPOT.TB in 56 (24%). At least one diagnostic test was positive in 109 (45%) patients and only among 13 (5%) patients were all three tests positive. Three (1%) QFT-GIT and 19 (8%) T-SPOT.TB test results were indeterminate. The agreement among all pairs of tests was poor: QFT-GIT vs. T-SPOT.TB (κ = 0.18, 95% CI .07-.30), QFT-GIT vs. TST (κ = 0.29, 95% CI .16-.42), and TST vs. T-SPOT.TB (κ = 0.22, 95% CI .07-.29). Risk factors for LTBI varied by diagnostic test and none showed associations between positive test results and well-known risk factors for TB, such as imprisonment, drug abuse and immunological status. CONCLUSIONS A high proportion of HIV patients had at least one positive diagnostic test for LTBI; however, there was very poor agreement among all tests. This lack of agreement makes it difficult to know which test is superior and most appropriate for LTBI testing among HIV-infected patients. While further follow-up studies will help determine the predictive ability of different LTBI tests, improved modalities are needed for accurate detection of LTBI and assessment of risk of developing active TB among HIV-infected patients.
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Affiliation(s)
- Nikoloz Chkhartishvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
| | - Russell R Kempker
- Division of Infectious Diseases, Emory University School of Medicine, 1364 Clifton Road, Atlanta, Georgia, 30322, , USA
| | - Natia Dvali
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
| | - Lela Abashidze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
| | - Lali Sharavdze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
- Tbilisi State University Faculty of Medicine, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
| | - Pati Gabunia
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
| | - Henry M Blumberg
- Division of Infectious Diseases, Emory University School of Medicine, 1364 Clifton Road, Atlanta, Georgia, 30322, , USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, , USA
- Center for AIDS Research, Emory University, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Carlos del Rio
- Division of Infectious Diseases, Emory University School of Medicine, 1364 Clifton Road, Atlanta, Georgia, 30322, , USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, , USA
- Center for AIDS Research, Emory University, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
- Tbilisi State University Faculty of Medicine, 16 Al. Kazbegi Avenue, Tbilisi, 0160, Georgia
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Abstract
Treatment of latent tuberculosis (TB) infection is an important component of TB control programs in both high- and low-prevalence countries. Clinical trials of treatment of latent TB conducted over several decades have demonstrated that preventive treatment can reduce the risk of developing active TB up to 90%. Although 9 months of daily, self-administered isoniazid has been the most widely used and recommended regimen for the treatment of latent infection, other regimens such as 3 months of daily isoniazid and rifampin, or 4 months of daily rifampin alone have also been recommended and used. Most recently, a 12-dose regimen of once-weekly isoniazid and rifapentine has been shown to be noninferior to 9 months of daily isoniazid in a large and well conducted clinical trial. Adoption of such a regimen on a large scale could have significant implications for TB elimination efforts.
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Affiliation(s)
- Madhavi J Parekh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Sultan B, Benn P, Mahungu T, Young M, Mercey D, Morris-Jones S, Miller RF. 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. Int J STD AIDS 2013; 24:775-9. [PMID: 23970606 PMCID: PMC4107858 DOI: 10.1177/0956462413486459] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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.
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Affiliation(s)
- B Sultan
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, UK
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Trajman A, Steffen RE, Menzies D. Interferon-Gamma Release Assays versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med 2013; 2013:601737. [PMID: 23476763 PMCID: PMC3582085 DOI: 10.1155/2013/601737] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for different indications for the use of these tests. We conclude that both tests are accurate to detect latent tuberculosis, although interferon-gamma release assays have higher specificity than tuberculin skin testing in BCG-vaccinated populations, particularly if BCG is received after infancy. However, both tests perform poorly to predict risk for progression to active tuberculosis. Interferon-gamma release assays have significant limitations in serial testing because of spontaneous variability and lack of a validated definition of conversion and reversion, making it difficult for clinicians to interpret changes in category (conversions and reversions). So far, the most important clinical evidence, that is, that isoniazid preventive therapy reduces the risk for progression to disease, has been produced only in tuberculin skin test-positive individuals.
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Affiliation(s)
- A. Trajman
- Gama Filho University, 20740-900 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
| | - R. E. Steffen
- Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil
| | - D. Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
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Ní Cheallaigh C, Fitzgerald I, Grace J, Jagjit Singh G, El-Eraki N, Gibbons N, Keane J, Rogers TR, Clarke S, Bergin C. Interferon gamma release assays for the diagnosis of latent TB infection in HIV-infected individuals in a low TB burden country. PLoS One 2013; 8:e53330. [PMID: 23382842 PMCID: PMC3559731 DOI: 10.1371/journal.pone.0053330] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 11/28/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Interferon gamma release assays (IGRAs) are used to diagnose latent tuberculosis infection. Two IGRAs are commercially available: the Quantiferon TB Gold In Tube (QFT-IT) and the T-SPOT.TB. There is debate as to which test to use in HIV+ individuals. Previous publications from high TB burden countries have raised concerns that the sensitivity of the QFT-IT assay, but not the T-SPOT.TB, may be impaired in HIV+ individuals with low CD4+ T-cell counts. We sought to compare the tests in a low TB burden setting. METHODOLOGY/PRINCIPAL FINDINGS T-SPOT.TB, QFT-IT, and tuberculin skin tests (TST) were performed in HIV infected individuals. Results were related to patient characteristics. McNemar's test, multivariate regression and correlation analysis were carried out using SPSS (SPSS Inc). 256 HIV infected patients were enrolled in the study. The median CD4+ T-cell count was 338 cells/µL (range 1-1328). 37 (14%) patients had a CD4+ T-cell count of <100 cells/µL. 46/256 (18% ) of QFT-IT results and 28/256 (11%) of T-SPOT.TB results were positive. 6 (2%) of QFT-IT and 18 (7%) of T-SPOT.TB results were indeterminate. An additional 9 (4%) of T-SPOT.TB results were unavailable as tests were not performed due to insufficient cells or clotting of the sample. We found a statistically significant association between lower CD4+ T-cell count and negative QFT-IT results (OR 1.055, p=0.03), and indeterminate/unavailable T-SPOT.TB results (OR 1.079, p=0.02). CONCLUSIONS/SIGNIFICANCE In low TB prevalence settings, the QFT-IT yields more positive and fewer indeterminate results than T-SPOT.TB. Negative results on the QFT-IT and indeterminate/unavailable results on the T-SPOT.TB were more common in individuals with low CD4+ T-cell counts.
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Affiliation(s)
- Clíona Ní Cheallaigh
- Department of Genito-Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
- * E-mail: (CNC); (CB)
| | - Ian Fitzgerald
- Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland
| | - Jacinta Grace
- Department of Genito-Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Gurmit Jagjit Singh
- Department of Genito-Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Nahla El-Eraki
- Department of Genito-Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Noel Gibbons
- Irish Mycobacterial Reference Laboratory, Central Pathology Laboratory, St James’s Hospital, Dublin, Ireland
| | - Joseph Keane
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - Thomas R. Rogers
- Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland
| | - Susan Clarke
- Department of Genito-Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Colm Bergin
- Department of Genito-Urinary Medicine and Infectious Diseases, St James’s Hospital, Dublin, Ireland
- * E-mail: (CNC); (CB)
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Park SW. Immunologic Diagnosis of Active Tuberculosis. Infect Chemother 2013; 45:110-2. [PMID: 24265959 PMCID: PMC3780941 DOI: 10.3947/ic.2013.45.1.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Sang-Won Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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32
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Kim YJ, Kim SI, Kim YR, Wie SH, Park YJ, Kang MW. Predictive value of interferon-γ ELISPOT assay in HIV 1-infected patients in an intermediate tuberculosis-endemic area. AIDS Res Hum Retroviruses 2012; 28:1038-43. [PMID: 22352311 DOI: 10.1089/aid.2011.0360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The tuberculin skin test for diagnosing latent tuberculosis (TB) has some limitations for HIV-infected patients, especially in BCG vaccinated countries. The objective of this study was to identify the incidence rate of new TB cases among HIV-infected patients in an intermediate TB-endemic area and to examine its correlation with the ELISPOT assay. We prospectively followed up 124 patients with HIV-1 infection to monitor development of active TB disease after performing an ELISPOT assay (T-SPOT. TB test, Oxford Immunotec, Ltd., Abingdon, UK). A total of 120 patients were followed for a median of 947 days; four patients with active TB at enrollment were excluded. Eleven patients developed active TB during 238 person-years, giving a high incidence rate of 4621/100,000 person-years. Patients with positive ELISPOT responses had a higher TB incidence rate than those with negative ELISPOT responses; however this was not statistically significant [20% (6/30) vs. 6.02% (5/83), p=0.052]. A Cox regression analysis showed that the independent risk factors associated with progression of TB were low CD4(+) T cell counts, previous history of TB treatment, and positive ELISPOT results. Advanced HIV-infected patients who showed a positive TB ELISPOT assay had a higher rate of progression to TB in the intermediate TB-endemic area.
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Affiliation(s)
- Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Il Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang Ree Kim
- Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon Joon Park
- Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Won Kang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Ramos JM, Robledano C, Masiá M, Belda S, Padilla S, Rodríguez JC, Gutierrez F. Contribution of interferon gamma release assays testing to the diagnosis of latent tuberculosis infection in HIV-infected patients: a comparison of QuantiFERON-TB Gold In Tube, T-SPOT.TB and tuberculin skin test. BMC Infect Dis 2012; 12:169. [PMID: 22849726 PMCID: PMC3482589 DOI: 10.1186/1471-2334-12-169] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 07/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most effective strategy to control tuberculosis (TB) among patients with HIV infection. The tuberculin skin test (TST) was the only available method to identify LTBI. The aim of the present work was to evaluate the usefulness of the interferon-gamma release assays (IGRAs): QuantiFERON-tuberculosis (TB) Gold-In-Tube test (QFG) and T-SPOT.TB for the diagnosis of LTBI in a diverse cohort of HIV-infected patients. METHODS A prospective study was carried out in consecutive patients cared for in a single institution in Spain from January 2009 to October 2010. IGRAs and TST were performed simultaneously. TST induration ≥ 5 mm was considered positive. RESULTS QFG, T-SPOT.TB and TST were performed in 373 subjects. Median CD4 cell count was 470/μl with a median nadir of 150/μl. TST, QFG and T-SPOT.TB were positive in 13.3%, 7.5% and 18.5% cases respectively. Among 277 patients with neither past or current TB nor previous treatment for LTBI and who had TST results, a positive TST result was obtained in 20 (7.2%) cases. When adding QFG results to TST, there were a total of 26 (8.6%) diagnoses of LTBI. When the results of both IGRAs were added, the number of diagnoses increased to 54 (17.9%) (incremental difference: 10.7% [95% confidence interval [CI]:5.3-16.2%] [p < 0.001]), and when both IGRAs were added, the number of diagnoses reached 56 (18.5%) (incremental difference: 11.3% [95% CI:5.7%-16.9%] [p < 0.001]). Patients with a CD4 cell count greater than 500 cells/μl and prior stay in prison were more likely to have a diagnosis of LTBI by TST and/or QFG and/or T-SPOT.TB (adjusted odds ratio [aOR]: 3.8; 95% CI, 1.4 - 9.9; and aOR: 3.3; 95% CI, 1.3 - 8.3, respectively). CONCLUSIONS IGRAs were more sensitive than TST for diagnosis of M. tuberculosis infection in HIV-infected patients. Dual sequential testing with TST and IGRAs may be the optimal approach for LTBI screening in this population.
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Affiliation(s)
- José M Ramos
- Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 12, 03203, Elche, Alicante, Spain.
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Diel R, Loddenkemper R, Nienhaus A. Predictive Value of Interferon-γ Release Assays and Tuberculin Skin Testing for Progression From Latent TB Infection to Disease State. Chest 2012; 142:63-75. [DOI: 10.1378/chest.11-3157] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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35
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Ramos JM, Masiá M, Rodríguez JC, López C, Padilla S, Robledano C, Navarro-Blasco FJ, Matarredona J, García-Sepulcre MF, Gutiérrez F. Negative effect of immunosuppressive therapy in the performance of the QuantiFERON Gold In-Tube test in patients with immune-mediated inflammatory diseases. Clin Exp Med 2012; 13:177-86. [DOI: 10.1007/s10238-012-0192-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/12/2012] [Indexed: 11/30/2022]
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Mitchell JE, Chetty S, Govender P, Pillay M, Jaggernath M, Kasmar A, Ndung’u T, Klenerman P, Walker BD, Kasprowicz VO. Prospective monitoring reveals dynamic levels of T cell immunity to Mycobacterium tuberculosis in HIV infected individuals. PLoS One 2012; 7:e37920. [PMID: 22685549 PMCID: PMC3369919 DOI: 10.1371/journal.pone.0037920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 04/26/2012] [Indexed: 11/18/2022] Open
Abstract
Monitoring of latent Mycobacterium tuberculosis infection may prevent disease. We tested an ESAT-6 and CFP-10-specific IFN-γ Elispot assay (RD1-Elispot) on 163 HIV-infected individuals living in a TB-endemic setting. An RD1-Elispot was performed every 3 months for a period of 3–21 months. 62% of RD1-Elispot negative individuals were positive by cultured Elispot. Fluctuations in T cell response were observed with rates of change ranging from −150 to +153 spot-forming cells (SFC)/200,000 PBMC in a 3-month period. To validate these responses we used an RD1-specific real time quantitative PCR assay for monokine-induced by IFN-γ (MIG) and IFN-γ inducible protein-10 (IP10) (MIG: r = 0.6527, p = 0.0114; IP-10: r = 0.6967, p = 0.0056; IP-10+MIG: r = 0.7055, p = 0.0048). During follow-up 30 individuals were placed on ARVs and 4 progressed to active TB. Fluctuations in SFC did not correlate with CD4 count, viral load, treatment initiation, or progression to active TB. The RD1-Elispot appears to have limited value in this setting.
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Affiliation(s)
- Jessica E. Mitchell
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT) and Harvard, Harvard Medical School, Boston, Massachusetts, United States of America
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Shivan Chetty
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Pamla Govender
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Mona Pillay
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Manjeetha Jaggernath
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Anne Kasmar
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thumbi Ndung’u
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT) and Harvard, Harvard Medical School, Boston, Massachusetts, United States of America
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Paul Klenerman
- Oxford Biomedical Research Centre and James Martin School for 21st Century, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bruce D. Walker
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT) and Harvard, Harvard Medical School, Boston, Massachusetts, United States of America
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Victoria O. Kasprowicz
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT) and Harvard, Harvard Medical School, Boston, Massachusetts, United States of America
- Kwazulu-Natal Research Institute for Tuberculosis and Human Immunodeficiency Virus (HIV) (K-RITH), Nelson R. Mandela School of Medicine, Durban, South Africa
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, Durban, South Africa
- * E-mail:
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Santin M, Muñoz L, Rigau D. Interferon-γ release assays for the diagnosis of tuberculosis and tuberculosis infection in HIV-infected adults: a systematic review and meta-analysis. PLoS One 2012; 7:e32482. [PMID: 22403663 PMCID: PMC3293815 DOI: 10.1371/journal.pone.0032482] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 01/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the widespread use of interferon-γ release assays (IGRAs), their role in diagnosing tuberculosis and targeting preventive therapy in HIV-infected patients remains unclear. We conducted a comprehensive systematic review to contribute to the evidence-based practice in HIV-infected people. METHODOLOGY/PRINCIPAL FINDINGS We searched MEDLINE, Cochrane, and Biomedicine databases to identify articles published between January 2005 and July 2011 that assessed QuantiFERON®-TB Gold In-Tube (QFT-GIT) and T-SPOT®.TB (T-SPOT.TB) in HIV-infected adults. We assessed their accuracy for the diagnosis of tuberculosis and incident active tuberculosis, and the proportion of indeterminate results. The search identified 38 evaluable studies covering a total of 6514 HIV-infected participants. The pooled sensitivity and specificity for tuberculosis were 61% and 72% for QFT-GIT, and 65% and 70% for T-SPOT.TB. The cumulative incidence of subsequent active tuberculosis was 8.3% for QFT-GIT and 10% for T-SPOT.TB in patients tested positive (one study each), and 0% for QFT-GIT (two studies) and T-SPOT.TB (one study) respectively in those tested negative. Pooled indeterminate rates were 8.2% for QFT-GIT and 5.9% for T-SPOT.TB. Rates were higher in high burden settings (12.0% for QFT-GIT and 7.7% for T-SPOT.TB) than in low-intermediate burden settings (3.9% for QFT-GIT and 4.3% for T-SPOT.TB). They were also higher in patients with CD4(+) T-cell count <200 (11.6% for QFT-GIT and 11.4% for T-SPOT.TB) than in those with CD4(+) T-cell count ≥ 200 (3.1% for QFT-GIT and 7.9% for T-SPOT.TB). CONCLUSIONS/SIGNIFICANCE IGRAs have suboptimal accuracy for confirming or ruling out active tuberculosis disease in HIV-infected adults. While their predictive value for incident active tuberculosis is modest, a negative QFT-GIT implies a very low short- to medium-term risk. Identifying the factors associated with indeterminate results will help to optimize the use of IGRAs in clinical practice, particularly in resource-limited countries with a high prevalence of HIV-coinfection.
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Affiliation(s)
- Miguel Santin
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet, Barcelona, Spain.
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Fraisse P. Diagnostic des infections tuberculeuses latentes (sujets sains, sujets immunodéprimés ou amenés à l’être). Rev Mal Respir 2012; 29:277-318. [DOI: 10.1016/j.rmr.2011.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/11/2011] [Indexed: 01/30/2023]
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Pollock KM, Tam H, Grass L, Bowes S, Cooke GS, Pareek M, Montamat-Sicotte D, Kapembwa M, Taylor GP, Lalvani A. Comparison of screening strategies to improve the diagnosis of latent tuberculosis infection in the HIV-positive population: a cohort study. BMJ Open 2012; 2:e000762. [PMID: 22382123 PMCID: PMC3293130 DOI: 10.1136/bmjopen-2011-000762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND HIV is the most important risk factor for progression of latent tuberculosis infection (LTBI) to active tuberculosis (TB). Detection and treatment of LTBI is necessary to reduce the increasing burden of TB in the UK, but a unified LTBI screening approach has not been adopted. OBJECTIVE To compare the effectiveness of a TB risk-focused approach to LTBI screening in the HIV-positive population against current UK National Institute for Health and Clinical Excellence (NICE) guidance. DESIGN Prospective cohort study. SETTING Two urban HIV treatment centres in London, UK. PARTICIPANTS 114 HIV-infected individuals with defined TB risk factors were enrolled prospectively as part of ongoing studies into HIV and TB co-infection. OUTCOME MEASURES The yield and case detection rate of LTBI cases within the research study were compared with those generated by the NICE criteria. RESULTS 17/114 (14.9%, 95% CI 8.3 to 21.5) had evidence of LTBI. Limiting screening to those meeting NICE criteria for the general population (n=43) would have detected just over half of these, 9/43 (20.9%, 95% CI 8.3 to 33.5) and those meeting criteria for HIV co-infection (n=74) would only have captured 8/74(10.8%, 95% CI 3.6 to 18.1) cases. The case detection rates from the study and NICE approaches were not significantly different. LTBI was associated with the presence of multiple TB risk factors (p=0.002). CONCLUSION Adoption of a TB risk-focused screening algorithm that does not use CD4 count stratification could prevent more cases of TB reactivation, without changing the case detection rate. These findings should be used to inform a large-scale study to create unified guidelines.
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Affiliation(s)
- Katrina M Pollock
- Tuberculosis Research Unit, National Heart and Lung Institute, Imperial College London, London, UK
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40
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Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, Mwansa-Kambafwile J, Fielding K, Wilkinson RJ, Pai M. Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2012; 12:45-55. [PMID: 21846592 PMCID: PMC3568693 DOI: 10.1016/s1473-3099(11)70210-9] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND We aimed to assess whether interferon-γ release assays (IGRAs) can predict the development of active tuberculosis and whether the predictive ability of these tests is better than that of the tuberculin skin test (TST). METHODS Longitudinal studies of the predictive value for active tuberculosis of in-house or commercial IGRAs were identified through searches of PubMed, Embase, Biosis, and Web of Science and complementary manual searches up to June 30, 2011. Eligible studies included adults or children, with or without HIV, who were free of active tuberculosis at study baseline. We summarised incidence rates in forest plots and pooled data with random-effects models when appropriate. We calculated incidence rate ratios (IRR) for rates of disease progression in IGRA-positive versus IGRA-negative individuals. FINDINGS 15 studies had a combined sample size of 26 680 participants. Incidence of tuberculosis during a median follow-up of 4 years (IQR 2-6), even in IGRA-positive individuals, was 4-48 cases per 1000 person-years. Seven studies with no possibility of incorporation bias and reporting baseline stratification on the basis of IGRA results showed a moderate association between positive results and subsequent tuberculosis (pooled unadjusted IRR 2·10, 95% CI 1·42-3·08). Compared with test-negative results, IGRA-positive and TST-positive results were much the same with regard to the risk of tuberculosis (pooled IRR in the five studies that used both was 2·11 [95% CI 1·29-3·46] for IGRA vs 1·60 [0·94-2·72] for TST at the 10 mm cutoff). However, the proportion of IGRA-positive individuals in seven of 11 studies that assessed both IGRAs and TST was generally lower than TST-positive individuals. INTERPRETATION Neither IGRAs nor the TST have high accuracy for the prediction of active tuberculosis, although use of IGRAs in some populations might reduce the number of people considered for preventive treatment. Until more predictive biomarkers are identified, existing tests for latent tuberculosis infection should be chosen on the basis of relative specificity in different populations, logistics, cost, and patients' preferences rather than on predictive ability alone. FUNDING Special Programme for Research and Training in Tropical Diseases (WHO), Wellcome Trust, Canadian Institutes of Health Research, UK Medical Research Council, and the European and Developing Countries Clinical Trials Partnership.
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Affiliation(s)
- Molebogeng X Rangaka
- Centre for Infectious Disease Research and Epidemiology, University of Cape Town, South Africa
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Kasprowicz VO, Churchyard G, Lawn SD, Squire SB, Lalvani A. Diagnosing latent tuberculosis in high-risk individuals: rising to the challenge in high-burden areas. J Infect Dis 2011; 204 Suppl 4:S1168-78. [PMID: 21996699 DOI: 10.1093/infdis/jir449] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A key challenge to greater progress in tuberculosis (TB) control is the reservoir of latent TB infection (LTBI), which represents a huge long-lived reservoir of potential TB disease. In parts of Africa, as many as 50% of 15-year-olds and 77%-89% of adults have evidence of LTBI. A second key challenge to TB control is the human immunodeficiency virus (HIV)-associated TB epidemic, and Africa alone accounts for one-quarter of the global burden of HIV-associated TB. HIV co-infection promotes both reactivation TB from LTBI and rapidly progressive primary TB following recent exposure to Mycobacterium tuberculosis. Preventing active TB and tackling latent infection in addition to the Directly Observed Treatment, Short-Course (DOTS) strategy could improve TB control in high-burden settings, especially where there is a high prevalence of HIV co-infection. Current strategies include intensified case finding (ICF), TB infection control, antiretroviral therapy (ART), and isoniazid preventive therapy (IPT). Although ART has been widely rolled out, ICF and IPT have not. A key factor limiting the rollout and effectiveness of IPT and ICF is the limitations of existing tools to both diagnose LTBI and identify those persons most at risk of progressing to active TB. In this review, we examine the obstacles and consider current progress toward the development of new tools to address this pressing global problem.
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Affiliation(s)
- Victoria O Kasprowicz
- Ragon Institute of MGH, MIT, and Harvard, Harvard Medical School, Boston, Massachusetts, USA
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Arias Guillén M. Avances en el diagnóstico de la infección tuberculosa. Arch Bronconeumol 2011; 47:521-30. [DOI: 10.1016/j.arbres.2011.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 06/03/2011] [Accepted: 06/11/2011] [Indexed: 01/22/2023]
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Cattamanchi A, Smith R, Steingart KR, Metcalfe JZ, Date A, Coleman C, Marston BJ, Huang L, Hopewell PC, Pai M. Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 2011; 56:230-8. [PMID: 21239993 PMCID: PMC3383328 DOI: 10.1097/qai.0b013e31820b07ab] [Citation(s) in RCA: 201] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether interferon-gamma release assays (IGRAs) improve the identification of HIV-infected individuals who could benefit from latent tuberculosis infection therapy. DESIGN Systematic review and meta-analysis. METHODS We searched multiple databases through May 2010 for studies evaluating the performance of the newest commercial IGRAs (QuantiFERON-TB Gold In-Tube [QFT-GIT] and T-SPOT.TB [TSPOT]) in HIV-infected individuals. We assessed the quality of all studies included in the review, summarized results in prespecified subgroups using forest plots, and where appropriate, calculated pooled estimates using random effects models. RESULTS The search identified 37 studies that included 5736 HIV-infected individuals. In three longitudinal studies, the risk of active tuberculosis was higher in HIV-infected individuals with positive versus negative IGRA results. However, the risk difference was not statistically significant in the two studies that reported IGRA results according to manufacturer-recommended criteria. In persons with active tuberculosis (a surrogate reference standard for latent tuberculosis infection), pooled sensitivity estimates were heterogeneous but higher for TSPOT (72%; 95% confidence interval [CI], 62-81%) than for QFT-GIT (61%; 95% CI, 47-75%) in low-/middle-income countries. However, neither IGRA was consistently more sensitive than the tuberculin skin test in head-to-head comparisons. Although TSPOT appeared to be less affected by immunosuppression than QFT-GIT and the tuberculin skin test, overall, differences among the three tests were small or inconclusive. CONCLUSIONS Current evidence suggests that IGRAs perform similarly to the tuberculin skin test at identifying HIV-infected individuals with latent tuberculosis infection. Given that both tests have modest predictive value and suboptimal sensitivity, the decision to use either test should be based on country guidelines and resource and logistic considerations.
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Affiliation(s)
- Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, USA
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, USA
| | - Rachel Smith
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, USA
| | - Karen R. Steingart
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, USA
| | - John Z. Metcalfe
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, USA
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, USA
| | - Anand Date
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, USA
| | - Courtney Coleman
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, USA
| | - Barbara J. Marston
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, USA
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, USA
- HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, USA
| | - Philip C. Hopewell
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, USA
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, USA
| | - Madhukar Pai
- Dept. of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
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Chen J, Sun J, Zhang R, Liu L, Zheng Y, Shen Y, Wang Z, Sun F, Li L, Lu H. T-SPOT.TB in the diagnosis of active tuberculosis among HIV-infected patients with advanced immunodeficiency. AIDS Res Hum Retroviruses 2011; 27:289-94. [PMID: 20977360 DOI: 10.1089/aid.2010.0062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the performance of T-SPOT.TB (a commercial interferon gamma release assay) and its accuracy for the diagnosis of active tuberculosis (TB) among HIV-infected subjects with advanced immunodeficiency. In a clinical prospective study, we assessed the performance of T-SPOT.TB for the diagnosis of active TB in HIV-infected patients with CD4 cell counts below 350 cells/mm(3) who were naive to antiretroviral and anti-TB therapies. Results were available from 147 patients, of whom 38 (25.9%) had active TB. The majority (85%) of the participants were male, with a median age of 40 years and a median CD4 cell count of 77 cells/mm(3). T-SPOT.TB yielded 15 (10.2%) indeterminate results. The indeterminate results were not associated with CD4 cell counts. However, younger patients were more likely to have an indeterminate result (OR = 0.91 per unit increase in age, p = 0.007). After excluding the indeterminate results, the sensitivity of T-SPOT.TB for the diagnosis of active TB was 37.1% and the specificity was 88.7%. The sensitivity of the T-SPOT.TB was independent of the CD4 cell count. However, its specificity was higher when used for patients with CD4 cell counts <100 cells/mm(3) when compared to patients with CD4 cell counts ≥100 cells/mm(3) (97.9% vs. 79.6%, p = 0.008). T-SPOT.TB could not be used as a routine tool to screen for active TB among HIV-infected patients with advanced immunodeficiency because of its poor performance and low sensitivity. However, it may be used as an adjunctive tool to diagnose active TB in this population due to its high specificity.
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Affiliation(s)
- Jun Chen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Jianjun Sun
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Renfang Zhang
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Li Liu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Yufang Zheng
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Yinzhong Shen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Zhenyan Wang
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Fuyan Sun
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Li Li
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
- Department of Infectious Diseases, HuaShan Hospital, Fudan University, Shanghai, China
- Department of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, China
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Santín Cerezales M, Benítez JD. Diagnosis of tuberculosis infection using interferon-γ-based assays. Enferm Infecc Microbiol Clin 2011; 29 Suppl 1:26-33. [DOI: 10.1016/s0213-005x(11)70015-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Chaudhary M, Gupta S, Khare S, Lal S. Diagnosis of tuberculosis in an era of HIV pandemic: a review of current status and future prospects. Indian J Med Microbiol 2011; 28:281-9. [PMID: 20966555 DOI: 10.4103/0255-0857.71805] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
HIV and tuberculosis co-infection interact in fundamentally important ways. This interaction is evident patho-physiologically, clinically and epidemiologically. There are several differences between HIV-infected and HIV-uninfected patients with tuberculosis (TB) that have practical diagnostic implications. TB is more likely to be disseminated in nature and more difficult to diagnose by conventional diagnostic procedures as immunosuppression progresses. As TB rates continue to increase in HIV-endemic regions, improved diagnostic techniques merit consideration as TB-control strategies. There is a need to develop more user friendly techniques, which can be adapted for use in the high-burden and low-income countries. This review focuses on the diagnostic challenges in HIV-TB co-infection with an update on the current techniques and future prospects in an era of HIV pandemic.
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Affiliation(s)
- M Chaudhary
- Microbiology Division, National Institute of Communicable Diseases, Delhi, India.
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HIV-1/mycobacterium tuberculosis coinfection immunology: how does HIV-1 exacerbate tuberculosis? Infect Immun 2011; 79:1407-17. [PMID: 21245275 DOI: 10.1128/iai.01126-10] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Human immunodeficiency virus type 1 (HIV) and Mycobacterium tuberculosis have become intertwined over the past few decades in a "syndemic" that exacerbates the morbidity and mortality associated with each pathogen alone. The severity of the coinfection has been extensively examined in clinical studies. The extrapolation of peripheral evidence from clinical studies has increased our basic understanding of how HIV increases susceptibility to TB. These studies have resulted in multiple hypotheses of how HIV exacerbates TB pathology through the manipulation of granulomas. Granulomas can be located in many tissues, most prominently the lungs and associated lymph nodes, and are made up of multiple immune cells that can actively contain M. tuberculosis. Granuloma-based research involving both animal models and clinical studies is needed to confirm these hypotheses, which will further our understanding of this coinfection and may lead to better treatment options. This review examines the data that support each hypothesis of how HIV manipulates TB pathology while emphasizing a need for more tissue-based experiments.
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IFN-γ response on T-cell based assays in HIV-infected patients for detection of tuberculosis infection. BMC Infect Dis 2010; 10:348. [PMID: 21143955 PMCID: PMC3016378 DOI: 10.1186/1471-2334-10-348] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 12/10/2010] [Indexed: 11/10/2022] Open
Abstract
Background Individuals infected with human immunodeficiency virus (HIV) have an increased risk of progression to active tuberculosis following Mycobacterium tuberculosis infection. The objective of the study was to determine IFN-γ responses for the detection of latent tuberculosis infection (LTBI) with QuantiFERON-TB GOLD In Tube (QFT-G-IT) and T-SPOT.TB in HIV patients, and evaluate the influence of CD4 cell count on tests performance. Methods We studied 75 HIV patients enrolled for ongoing studies of LTBI with T-SPOT.TB, QFN-G-IT and TST. Mean CD4 cell counts ± standard deviation was 461.29 ± 307.49 cells/μl. Eight patients had a BCG scar. Results T-SPOT.TB, QFN-G-IT and TST were positive in 7 (9.3%), 5 (6.7%) and 9 (12%) cases, respectively. Global agreement between QFN-G-IT and T-SPOT.TB was 89% (κ = 0.275). The overall agreement of T-SPOT.TB and QFN-G-IT with TST was 80.8% (κ = 0.019) and 89% (κ = 0.373), respectively. We have found negative IFN-γ assays results among 2 BCG-vaccinated HIV-infected individuals with a positive TST. In non BCG-vaccinated patients, QFN-G-IT and TST were positive in 5 cases (7.5%) and T-SPOT.TB in 7 (10.4%). In contrast, in BCG-vaccinated patients, only TST was positive in 4/8 (50%) of the cases. The differences obtained in the number of positive results between TST and both IFN-γ assays in BCG vaccinated patients were significant (95% CI 3-97%, p = 0.046), however, the confidence interval is very wide given the small number of patients. In patients with CD4< 200, we obtained only one (5%) positive result with T-SPOT.TB; however, QFN-G-IT and TST were negative in all cases. On the contrary, percentages of positive results in patients with CD4> 200 were 10.9% (6/55), 9.1% (5/55) and 16.4% (9/55) with T-SPOT.TB, QFN-G-IT and TST, respectively. Conclusions IFN-γ tests have the benefit over TST that are less influenced by BCG vaccination, consequently they are more specific than TST. Although our number of patients with advance immunosuppression is limited, our study suggests that IFN-γ assays are influenced with level of immunosuppression. The use of IFN-γ assays could be a helpful method for diagnosing LTBI in HIV population.
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