Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 175, Issue 7, Pages 737-742Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.200608-1088OC
Keywords
latent tuberculosis infection; human immunodeficiency virus; QuantiFERON; interferon-gamma assay; tuberculin skin test
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Funding
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [K24AI051982, P30AI027763] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF MENTAL HEALTH [T32MH019105, R01MH054907] Funding Source: NIH RePORTER
- NIAID NIH HHS [5 P30 AI27763, P30 AI027763, K24-AI51982] Funding Source: Medline
- NIMH NIH HHS [T32 MH-19105-16, R01 MH054907, R01 MH54908] Funding Source: Medline
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Rationale: Although interferon (IFN)-gamma release assays are approved for the diagnosis of latent tuberculosis infection (LTBI), limited data exist regarding their performance in HIV infection. Objectives: To compare tuberculin skin test (TST) results to the commercial IFN-gamma release assay QuantiFERON-TB Gold In-Tube (QFT) for the diagnosis of LTBI in HIV-infected adults. Methods: A total of 294 HIV-infected subjects sampled from two San Francisco cohorts underwent TST, using 5 TU of purified protein derivative, and QFT, measuring IFN-gamma response to Mycobacterium tuberculosis-specific RD-1 antigens. Main Results: Of 294 participants, 205 (70%) returned for an evaluable TST. Concordance between QFT and TST was 89.3% (kappa = 0.37, p = 0.007). However, in subjects with positive test results by either TST or QFT, only 28% (8/29) had positive test results by both modalities. TST-positive/QFT-negative discordant results were found in 5.1% of subjects and TST-negative/QFT-positive discordance in 5.6%. Indeterminate QFT results occurred in 5.1%, all due to a failure to respond to the phytohemagglutinin-positive control. Subjectswith a CD4(+) count of less than 100 cells/mm(3) had a relative risk of an indeterminate result of 4.24 (95% confidence interval, 1.55-11.61; p= 0.003) compared with those with a CD4(+) count of 100 or more. Conclusions: Overall concordance between QFT and TST in HIV-infection was high, but agreement among subjects with positive tests by either modality was low.
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