Free Content High level of discordant IGRA results in HIV-infected adults and children

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Abstract:

SETTING: Tygerberg district, Western Cape Province, South Africa.

OBJECTIVE: To measure the agreement of two interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for the detection of Mycobacterium tuberculosis infection in human immunodeficiency virus (HIV) infected adults and children in a setting highly endemic for tuberculosis (TB).

DESIGN: Cross-sectional study.

RESULTS: In HIV-infected adults (n = 20) and children (n = 23), tests yielded discordant results, with 61% of individuals testing positive with T-SPOT.TB, 41% with TST and 28% with QuantiFERON® TB Gold (QTF). In children, there was poor agreement between the TST and T-SPOT.TB (kappa [κ] = −0.02), but moderate agreement between the TST and QTF (κ = 0.44). In adults, there was moderate agreement between the TST and T-SPOT.TB (κ = 0.43), and the TST and QTF (κ = 0.46). In children and adults, there was fair agreement between the T-SPOT.TB and QTF (κ = 0.33). Twenty per cent of adults had ≥1 indeterminate IGRA results.

CONCLUSIONS: There is poor to moderate agreement between the TST and IGRAs in HIV-infected adults and children. T-SPOT.TB may have improved sensitivity for detection of M. tuberculosis infection in HIV-infected individuals compared to the QTF and the TST. In HIV-infected individuals, IGRA test properties are affected by test cut-off point and nil control responses.

Keywords: CD4; CFP-10; ESAT-6; HIV; M. tuberculosis; exposure age; interferon-gamma release assays

Document Type: Regular Paper

Affiliations: 1: Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA 2: Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa 3: Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA

Publication date: April 1, 2008

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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