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Free Content Predictors of discordant tuberculin skin test and QuantiFERON®-TB Gold In-Tube results in various high-risk groups

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.

Keywords: QuantiFERON-TB Gold In-Tube; discordance; latent tuberculosis infection; tuberculin skin test

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

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