Authors: Pai, M.¹; Joshi, R.²; Dogra, S.³; Zwerling, A.A.¹; Gajalakshmi, D.⁴; Goswami, K.⁴; Reddy, M.V.R.⁴; Kalantri, A.⁴; Hill, P.C.⁵; Menzies, D.¹; Hopewell, P.C.⁶

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 1, January 2009 , pp. 84-92(9)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

BACKGROUND: Interferon-gamma assays (IGRAs) are alternatives to the tuberculin skin test (TST), but IGRA conversions and reversions are not well understood. In a pilot study, we determined conversions and reversions using QuantiFERON-TB Gold In-Tube^® (QFT) among household contacts of TB cases, and evaluated the effect of using various definitions and criteria for conversions.

DESIGN: In a cohort of 250 contacts in India, 46% were TST-positive at baseline and 54% were QFT-positive. We re-tested this cohort after 12 months. Conversion rates were estimated using several definitions.

RESULTS: Of the 250 contacts, 205 (82%) underwent repeat testing. Among 85 contacts with baseline TST-negative/QFT-negative results, TST conversion rates ranged between 7.5% and 13.8%, and QFT conversion rates ranged between 11.8% and 21.2%, depending on the definitions used. Among 109 contacts who were QFT-positive at baseline, seven (6.4%) had QFT reversions. QFT reversions were most likely when the baseline TST was negative and QFT results were just above the diagnostic cut-off.

CONCLUSIONS: QFT conversions and reversions occurred among contacts of TB cases. Conversion rates seemed to vary, depending on the test and definitions used for conversions. These findings need to be verified in larger studies in various settings.

Keywords: tuberculosis; interferon-gamma assay; tuberculin skin test; QuantiFERON-TB Gold; contacts; serial testing

Document Type: Regular paper

Affiliations: 1: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada 2: Mahatma Gandhi Institute of Medical Sciences, Sevagram, India; Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA 3: ASC College of Medical Sciences & Hospital, Sidhra, Jammu, India 4: Mahatma Gandhi Institute of Medical Sciences, Sevagram, India 5: Centre for International Health, University of Otago, Dunedin, New Zealand 6: Division of Pulmonary & Critical Care Medicine, San Francisco General Hospital and University of California, San Francisco, California, USA

Publication date: 2009-01-01

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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.

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