Interferon-γ release assay as a sensitive diagnostic tool of latent tuberculosis infection in patients with HIV: a cross-sectional study

Abstract

BackgroundIn developing countries, tuberculosis (TB) is a major public health problem and the leading cause of death among patients with HIV (Human Immunodeficiency Virus). Until 2001, the tuberculin skin test (TST) was the only available tool for the diagnosis of latent tuberculosis infection (LTBI), but false-negative TST results are frequently reported. Recently, the interferon-γ (IFN-γ) release assay (IGRA) has gained ground because it can detect the IFN-γ secreted by circulating lymphocytes T cells when stimulated by specific TB antigens. However, the role of IGRA in the diagnosis of LTBI in HIV-infected patients has not been well established.MethodsThis cross-sectional study compared the accuracy of TST (performed by the Mantoux method) and IGRA (QuantiFERON-TB Gold In-Tube, Cellestis, Carnegie, Australia) on the diagnosis of LTBI among patients with HIV. LTBI is defined by LTBI risk and at least one positive test (TST or IGRA), without clinical evidence of active TB. We also assessed the accuracy of TST and IGRA among HIV patients with high and low risk for LTBI.ResultsAmong 90 HIV patients, 80 met the study criteria for LTBI, fifty-nine (73.7%) patients were TST positive, 21 (26.2%) were negative, whereas 75 patients (93.7%) were IGRA positive, and five (6.2%) were negative. TST showed poor agreement with the diagnosis of LTBI (Kappa: 0.384), while IGRA demonstrated good agreement (Kappa: 0.769). Among 69 patients with high risk and 21 with low risk for LTBI, TST was positive in 48 (69.5%) and 11 (52.4%), while IGRA was positive in 68 (98.5%) and 7 (33.3%) patients, respectively. There were no association between TST and the level of risk (P = 0,191). Conversely, we observed a strong association between the IGRA and risk for LTBI (p < 0.001).ConclusionsCompared to TST, IGRA positivity is consistent with the risk of TB infection and seems to be a better diagnostic tool for LTBI in HIV-infected patients.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3508-8) contains supplementary material, which is available to authorized users.

<p>The Prevalence and Demographic Risk Factors for Latent Tuberculosis Infection (LTBI) Among Healthcare Workers in Semarang, Indonesia</p>

“…36 Furthermore, based on the results of previous studies, the IGRA test also shows more consistent results than the TST for screening the LTBI in immunocompromised patients, such as HIV. 37 Age is associated with a relatively high TB prevalence. Most of the respondents in this study were aged <40 years amounted to 129 (66.15%) out of 195.…”

Comparative analysis of Mycobacterium tuberculosis-specific antigens and T-cell mitogen-stimulated interferon gamma production in hemodialysis patients and healthy individuals

“…TB is one of the top 10 causes of death in the world, and the leading cause from a single infectious agent (ranking above HIV/AIDS) [7]. Millions of people continue to fall sick with TB each year [15].…”

The diagnostic performance of TB-IGRA on HIV infected patients with active tuberculosis is associated with CD4+ T-cell counts

“…The immunodiagnosis of Mycobacterium tuberculosis (MTB) infection was a new adjuvant method. The interferon-gamma release assay (IGRA) was one of the most important advances of immunodiagnosis, and has been widely applied and accepted in the clinic [4,5]. Enzyme-linked immunosorbent spot (ELISPOT) assay and enzyme-linked immunosorbent assay (ELISA), both through detecting released IFNγ in culture supernatants, are two forms of the IGRA.…”