Predictors of discordant tuberculin skin test and QuantiFERON®-TB Gold In-Tube results in various high-risk groups
Abstract:SETTING: Persons in whom targeted testing for latent tuberculosis infection (LTBI) is recommended in Seattle, Washington; Atlanta, Georgia; and central North Carolina, United States.
OBJECTIVE: To compare the performance of an interferon-gamma release assay (QuantiFERON®-TB Gold In-Tube [QFT-GIT]) with the tuberculin skin test (TST) among foreign-born, homeless, human immunodeficiency virus (HIV) infected and substance abuse persons tested for LTBI.
DESIGN: A cross-sectional study requiring participants to have a blood test, a TST and data collected.
RESULTS: Of 1653 persons, 19.5% were TST-positive and 14.0% were QFT-GIT-positive. Overall concordance was moderate (kappa 0.53; 95%CI 0.47–0.58). Compared to concordant positive results, TST+/QFT-GIT− discordance was associated with HIV infection and sex, while TST−/QFT-GIT+ discordance was associated with HIV and inversely associated with foreign birth. Compared to concordant negative results, TST−/QFT-GIT+ discordance was associated with foreign birth and age ≥50 years, while TST+/QFT-GIT-discordance was associated with foreign birth, age 30–49 years, being Black and inversely associated with HIV. HIV infection was significantly associated with indeterminate QFT-GIT results.
CONCLUSION: QFT-GIT may be an improvement over the TST for diagnosing LTBI in foreign-born and older persons, and may be as useful as the TST in HIV-infected persons. The sensitivity of both tests may be low in HIV-infected persons.
Document Type: Regular Paper
Affiliations: 1: Westat, Rockville, Maryland, USA 2: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA 3: Snohomish Health District, Everett, Washington, USA 4: RTI International, Research Triangle Park, North Carolina, USA 5: Seattle-King County Department of Public Health, Seattle, Washington, USA 6: Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: August 1, 2011
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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