Comparison of an interferon-γ release assay with tuberculin skin testing in HIV-infected individuals

Annie F. Luetkemeyer, Edwin D. Charlebois, Laura L. Flores, David Bangsberg, Steven G. Deeks, Jeffrey N. Martin, Diane V. Havlir

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

Rationale: Although interferon (IFN)-γ release assays are approved for the diagnosis of latent tuberculosis infection (LTBI), limited data exist regarding their performance in HIV infection. Objectives: To compare tuberculin skin test (TST) results to the commercial IFN-γ release assay QuantiFERON-TB Gold In-Tube (QFT) for the diagnosis of LTBI in HIV-infected adults. Methods: A total of 294 HIV-infected subjects sampled from two San Francisco cohorts underwent TST, using 5 TU of purified protein derivative, and QFT, measuring IFN-γ response to Mycobacterium tuberculosis-specific RD-1 antigens. Main Results: Of 294 participants, 205 (70%) returned for an evaluable TST. Concordance between QFT and TST was 89.3% (kappa = 0.37, p = 0.007). However, in subjects with positive test results by either TST or QFT, only 28% (8/29) had positive test results by both modalities. TST-positive/QFT-negative discordant results were found in 5.1% of subjects and TST-negative/QFT-positive discordance in 5.6%. Indeterminate QFT results occurred in 5.1%, all due to a failure to respond to the phytohemagglutinin-positive control. Subjects with a CD4+ count of less than 100 cells/mm3 had a relative risk of an indeterminate result of 4.24 (95% confidence interval, 1.55-11.61; p= 0.003) compared with those with a CD4+ count of 100 or more. Conclusions: Overall concordance between QFT and TST in HIV infection was high, but agreement among subjects with positive tests by either modality was low.

Original languageEnglish (US)
Pages (from-to)737-742
Number of pages6
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume175
Issue number7
DOIs
StatePublished - Apr 1 2007
Externally publishedYes

Fingerprint

Tuberculin Test
Tuberculin
Skin Tests
Gold
Interferons
HIV
Skin
Latent Tuberculosis
CD4 Lymphocyte Count
HIV Infections
San Francisco
Phytohemagglutinins
Mycobacterium tuberculosis
Confidence Intervals
Antigens

Keywords

  • Human immunodeficiency virus
  • Interferon-γ assay
  • Latent tuberculosis infection
  • QuantiFERON
  • Tuberculin skin test

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Comparison of an interferon-γ release assay with tuberculin skin testing in HIV-infected individuals. / Luetkemeyer, Annie F.; Charlebois, Edwin D.; Flores, Laura L.; Bangsberg, David; Deeks, Steven G.; Martin, Jeffrey N.; Havlir, Diane V.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 175, No. 7, 01.04.2007, p. 737-742.

Research output: Contribution to journalArticle

Luetkemeyer, Annie F. ; Charlebois, Edwin D. ; Flores, Laura L. ; Bangsberg, David ; Deeks, Steven G. ; Martin, Jeffrey N. ; Havlir, Diane V. / Comparison of an interferon-γ release assay with tuberculin skin testing in HIV-infected individuals. In: American Journal of Respiratory and Critical Care Medicine. 2007 ; Vol. 175, No. 7. pp. 737-742.
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abstract = "Rationale: Although interferon (IFN)-γ release assays are approved for the diagnosis of latent tuberculosis infection (LTBI), limited data exist regarding their performance in HIV infection. Objectives: To compare tuberculin skin test (TST) results to the commercial IFN-γ release assay QuantiFERON-TB Gold In-Tube (QFT) for the diagnosis of LTBI in HIV-infected adults. Methods: A total of 294 HIV-infected subjects sampled from two San Francisco cohorts underwent TST, using 5 TU of purified protein derivative, and QFT, measuring IFN-γ response to Mycobacterium tuberculosis-specific RD-1 antigens. Main Results: Of 294 participants, 205 (70{\%}) returned for an evaluable TST. Concordance between QFT and TST was 89.3{\%} (kappa = 0.37, p = 0.007). However, in subjects with positive test results by either TST or QFT, only 28{\%} (8/29) had positive test results by both modalities. TST-positive/QFT-negative discordant results were found in 5.1{\%} of subjects and TST-negative/QFT-positive discordance in 5.6{\%}. Indeterminate QFT results occurred in 5.1{\%}, all due to a failure to respond to the phytohemagglutinin-positive control. Subjects with a CD4+ count of less than 100 cells/mm3 had a relative risk of an indeterminate result of 4.24 (95{\%} confidence interval, 1.55-11.61; p= 0.003) compared with those with a CD4+ count of 100 or more. Conclusions: Overall concordance between QFT and TST in HIV infection was high, but agreement among subjects with positive tests by either modality was low.",
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AU - Luetkemeyer, Annie F.

AU - Charlebois, Edwin D.

AU - Flores, Laura L.

AU - Bangsberg, David

AU - Deeks, Steven G.

AU - Martin, Jeffrey N.

AU - Havlir, Diane V.

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AB - Rationale: Although interferon (IFN)-γ release assays are approved for the diagnosis of latent tuberculosis infection (LTBI), limited data exist regarding their performance in HIV infection. Objectives: To compare tuberculin skin test (TST) results to the commercial IFN-γ release assay QuantiFERON-TB Gold In-Tube (QFT) for the diagnosis of LTBI in HIV-infected adults. Methods: A total of 294 HIV-infected subjects sampled from two San Francisco cohorts underwent TST, using 5 TU of purified protein derivative, and QFT, measuring IFN-γ response to Mycobacterium tuberculosis-specific RD-1 antigens. Main Results: Of 294 participants, 205 (70%) returned for an evaluable TST. Concordance between QFT and TST was 89.3% (kappa = 0.37, p = 0.007). However, in subjects with positive test results by either TST or QFT, only 28% (8/29) had positive test results by both modalities. TST-positive/QFT-negative discordant results were found in 5.1% of subjects and TST-negative/QFT-positive discordance in 5.6%. Indeterminate QFT results occurred in 5.1%, all due to a failure to respond to the phytohemagglutinin-positive control. Subjects with a CD4+ count of less than 100 cells/mm3 had a relative risk of an indeterminate result of 4.24 (95% confidence interval, 1.55-11.61; p= 0.003) compared with those with a CD4+ count of 100 or more. Conclusions: Overall concordance between QFT and TST in HIV infection was high, but agreement among subjects with positive tests by either modality was low.

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KW - Latent tuberculosis infection

KW - QuantiFERON

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