Authors: Mandalakas, A.M.¹; Hesseling, A.C.²; Chegou, N.N.³; Kirchner, H.L.⁴; Zhu, X.¹; Marais, B.J.²; Black, G.F.³; Beyers, N.²; Walzl, G.³

Source: The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 4, April 2008 , pp. 417-423(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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

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: Division of Molecular Biology and Human Genetics, Department of Science and Technology/National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research and MRC Centre for Molecular and Cellular Biology, Faculty of Health Scie 4: Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA

Publication date: 2008-04-01

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