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Free Content Evaluation of QuantiFERON®-TB Gold In-Tube in human immunodeficiency virus infection and in patient candidates for anti-tumour necrosis factor-alpha treatment

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Abstract:

SETTING: Cross-sectional study at four out-patient clinics in a single referral centre in Italy.

OBJECTIVE: To evaluate the performance of QuantiFERON®-TB Gold In-Tube (QFT-GIT) in human immunodeficiency virus (HIV) infected adults and in patients with immune-mediated inflammatory diseases (IMIDs) who are candidates for anti-tumour necrosis factor-alpha (TNF-α) treatment.

DESIGN: A total of 402 immunocompromised patients were enrolled, including 207 HIV-infected individuals and 195 IMID patients scheduled for anti-TNF-α treatment. Tuberculin skin test (TST) and QFT-GIT were performed. For active tuberculosis (TB), test results were compared with microbiological, histopathological and clinical diagnoses.

RESULTS: In HIV-infected patients, the level of agreement between the tests was 68% and QFT-GIT sensitivity was 66% (95%CI 47–82). We found a large proportion of indeterminate QFT-GIT results (33.4%), which correlated with CD4 count < 200 cells/μl (P < 0.0001). The degree of agreement with TST was higher in IMID patients (81.6%). Factors associated with discordant positive TST and negative QFT-GIT results were bacille Calmette-Guérin vaccination (P = 0.0001), previous TB (P = 0.0001) and agricultural work (P = 0.0005).

CONCLUSION: The performance of QFT-GIT varies between different types of immunocompromised patients. Interferon-gamma release assays should not be used to confirm or rule out a diagnosis of active TB in HIV-infected adults. As there were no cases of active TB in the IMID subgroup, it was difficult to determine which test performs better in this population.

Keywords: HIV infection; IFN-γ release assays; anti-TNF-α treatment; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Dipartimento di Malattie Infettive e Tropicali, Sapienza University, Rome, Italy 2: Dipartimento di Clinica e Terapia Medica, Reumatologia, Sapienza University, Rome, Italy 3: Unità Operativa Complessa Dermatologia, Sapienza University, Polo Pontino, Terracina, Italy 4: Unità Operativa Complessa Malattie Infettive, Sapienza University, Polo Pontino, Latina, Italy 5: Dipartimento di Malattie Infettive e Tropicali, Sapienza University, Rome, Italy; and Unità Operativa Complessa Malattie Infettive, Sapienza University, Polo Pontino, Latina, Italy

Publication date: 2010-07-01

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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.

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

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