Interferon-gamma release assays for diagnosis of latent tuberculosis infection: Evidence in immune-mediated inflammatory disorders

Rachel Smith, Adithya Cattamanchi, Karen R. Steingart, Claudia Denkinger, Keertan Dheda, Kevin Winthrop, Madhukar Pai

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: To provide a narrative synthesis of evidence on interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in individuals with immune-mediated inflammatory disorders (IMIDs). RECENT FINDINGS: Only a few studies have evaluated IGRAs in IMIDs, and most were small and varied considerably with respect to the use of immunosuppressive medications and types of IMIDs. Current evidence does not clearly suggest that IGRAs are better than tuberculin skin test (TST) in identifying individuals with IMID who could benefit from LTBI treatment. To date, no studies have been done on the predictive value of IGRAs in IMID patients. Important questions remain unanswered as to the impact of immunosuppressive medications and the impact of type of IMID on IGRA performance. SUMMARY: Despite the lack of clear evidence, there is an increasing tendency for guidelines to prefer IGRA over TST in IMIDs or to recommend both TST and IGRA to enhance sensitivity. We believe the use of either test is acceptable for LTBI screening. Clinicians could consider starting with IGRAs in individuals with a history of Bacille Calmette-Guérin (BCG) vaccination after infancy or with repeated BCG vaccinations. When the index of suspicion for LTBI is high, both IGRA and TST could be performed, especially prior to initiating TNF-α inhibitor therapy. Regardless of the test used, it is important to remember that in the face of immune-suppression, both IGRA and TST can be falsely negative and are thus only diagnostic aids-they will need to be interpreted with other clinical and risk factor data.

Original languageEnglish (US)
Pages (from-to)377-384
Number of pages8
JournalCurrent Opinion in Rheumatology
Volume23
Issue number4
DOIs
StatePublished - Jul 2011

Fingerprint

Interferon-gamma Release Tests
Latent Tuberculosis
Tuberculin Test
Skin Tests
Immunosuppressive Agents
Vaccination

Keywords

  • diagnostics
  • HIV
  • immune-mediated inflammatory diseases
  • interferon-gamma release assays
  • latent tuberculosis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Interferon-gamma release assays for diagnosis of latent tuberculosis infection : Evidence in immune-mediated inflammatory disorders. / Smith, Rachel; Cattamanchi, Adithya; Steingart, Karen R.; Denkinger, Claudia; Dheda, Keertan; Winthrop, Kevin; Pai, Madhukar.

In: Current Opinion in Rheumatology, Vol. 23, No. 4, 07.2011, p. 377-384.

Research output: Contribution to journalArticle

Smith, Rachel ; Cattamanchi, Adithya ; Steingart, Karen R. ; Denkinger, Claudia ; Dheda, Keertan ; Winthrop, Kevin ; Pai, Madhukar. / Interferon-gamma release assays for diagnosis of latent tuberculosis infection : Evidence in immune-mediated inflammatory disorders. In: Current Opinion in Rheumatology. 2011 ; Vol. 23, No. 4. pp. 377-384.
@article{3b7f2e95e16b4416818c3b793ba6e5c2,
title = "Interferon-gamma release assays for diagnosis of latent tuberculosis infection: Evidence in immune-mediated inflammatory disorders",
abstract = "PURPOSE OF REVIEW: To provide a narrative synthesis of evidence on interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in individuals with immune-mediated inflammatory disorders (IMIDs). RECENT FINDINGS: Only a few studies have evaluated IGRAs in IMIDs, and most were small and varied considerably with respect to the use of immunosuppressive medications and types of IMIDs. Current evidence does not clearly suggest that IGRAs are better than tuberculin skin test (TST) in identifying individuals with IMID who could benefit from LTBI treatment. To date, no studies have been done on the predictive value of IGRAs in IMID patients. Important questions remain unanswered as to the impact of immunosuppressive medications and the impact of type of IMID on IGRA performance. SUMMARY: Despite the lack of clear evidence, there is an increasing tendency for guidelines to prefer IGRA over TST in IMIDs or to recommend both TST and IGRA to enhance sensitivity. We believe the use of either test is acceptable for LTBI screening. Clinicians could consider starting with IGRAs in individuals with a history of Bacille Calmette-Gu{\'e}rin (BCG) vaccination after infancy or with repeated BCG vaccinations. When the index of suspicion for LTBI is high, both IGRA and TST could be performed, especially prior to initiating TNF-α inhibitor therapy. Regardless of the test used, it is important to remember that in the face of immune-suppression, both IGRA and TST can be falsely negative and are thus only diagnostic aids-they will need to be interpreted with other clinical and risk factor data.",
keywords = "diagnostics, HIV, immune-mediated inflammatory diseases, interferon-gamma release assays, latent tuberculosis",
author = "Rachel Smith and Adithya Cattamanchi and Steingart, {Karen R.} and Claudia Denkinger and Keertan Dheda and Kevin Winthrop and Madhukar Pai",
year = "2011",
month = "7",
doi = "10.1097/BOR.0b013e3283474d62",
language = "English (US)",
volume = "23",
pages = "377--384",
journal = "Current Opinion in Rheumatology",
issn = "1040-8711",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Interferon-gamma release assays for diagnosis of latent tuberculosis infection

T2 - Evidence in immune-mediated inflammatory disorders

AU - Smith, Rachel

AU - Cattamanchi, Adithya

AU - Steingart, Karen R.

AU - Denkinger, Claudia

AU - Dheda, Keertan

AU - Winthrop, Kevin

AU - Pai, Madhukar

PY - 2011/7

Y1 - 2011/7

N2 - PURPOSE OF REVIEW: To provide a narrative synthesis of evidence on interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in individuals with immune-mediated inflammatory disorders (IMIDs). RECENT FINDINGS: Only a few studies have evaluated IGRAs in IMIDs, and most were small and varied considerably with respect to the use of immunosuppressive medications and types of IMIDs. Current evidence does not clearly suggest that IGRAs are better than tuberculin skin test (TST) in identifying individuals with IMID who could benefit from LTBI treatment. To date, no studies have been done on the predictive value of IGRAs in IMID patients. Important questions remain unanswered as to the impact of immunosuppressive medications and the impact of type of IMID on IGRA performance. SUMMARY: Despite the lack of clear evidence, there is an increasing tendency for guidelines to prefer IGRA over TST in IMIDs or to recommend both TST and IGRA to enhance sensitivity. We believe the use of either test is acceptable for LTBI screening. Clinicians could consider starting with IGRAs in individuals with a history of Bacille Calmette-Guérin (BCG) vaccination after infancy or with repeated BCG vaccinations. When the index of suspicion for LTBI is high, both IGRA and TST could be performed, especially prior to initiating TNF-α inhibitor therapy. Regardless of the test used, it is important to remember that in the face of immune-suppression, both IGRA and TST can be falsely negative and are thus only diagnostic aids-they will need to be interpreted with other clinical and risk factor data.

AB - PURPOSE OF REVIEW: To provide a narrative synthesis of evidence on interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in individuals with immune-mediated inflammatory disorders (IMIDs). RECENT FINDINGS: Only a few studies have evaluated IGRAs in IMIDs, and most were small and varied considerably with respect to the use of immunosuppressive medications and types of IMIDs. Current evidence does not clearly suggest that IGRAs are better than tuberculin skin test (TST) in identifying individuals with IMID who could benefit from LTBI treatment. To date, no studies have been done on the predictive value of IGRAs in IMID patients. Important questions remain unanswered as to the impact of immunosuppressive medications and the impact of type of IMID on IGRA performance. SUMMARY: Despite the lack of clear evidence, there is an increasing tendency for guidelines to prefer IGRA over TST in IMIDs or to recommend both TST and IGRA to enhance sensitivity. We believe the use of either test is acceptable for LTBI screening. Clinicians could consider starting with IGRAs in individuals with a history of Bacille Calmette-Guérin (BCG) vaccination after infancy or with repeated BCG vaccinations. When the index of suspicion for LTBI is high, both IGRA and TST could be performed, especially prior to initiating TNF-α inhibitor therapy. Regardless of the test used, it is important to remember that in the face of immune-suppression, both IGRA and TST can be falsely negative and are thus only diagnostic aids-they will need to be interpreted with other clinical and risk factor data.

KW - diagnostics

KW - HIV

KW - immune-mediated inflammatory diseases

KW - interferon-gamma release assays

KW - latent tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=79958839671&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958839671&partnerID=8YFLogxK

U2 - 10.1097/BOR.0b013e3283474d62

DO - 10.1097/BOR.0b013e3283474d62

M3 - Article

C2 - 21519268

AN - SCOPUS:79958839671

VL - 23

SP - 377

EP - 384

JO - Current Opinion in Rheumatology

JF - Current Opinion in Rheumatology

SN - 1040-8711

IS - 4

ER -