The Clinical Usefulness of Tuberculin Skin Test versus Interferon-Gamma Release Assays for Diagnosis of Latent Tuberculosis in HIV Patients: A Meta-Analysis

Ayubi, Erfan; Doosti-Irani, Amin; Moghaddam, Ali Sanjari; Sani, Mohadeseh; Nazarzadeh, Milad; Mostafavi, Ehsan

doi:10.1371/journal.pone.0161983

Cited by 28 publications

(22 citation statements)

References 39 publications

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“…Our results are lower than those of the meta-analysis done by Ayubi et al [26] who found the prevalence of LTBI among HIV infected adults to be 59% (95% CI: 49, 69).…”

Section: Discussioncontrasting

confidence: 97%

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Kadima

Lutumba

Kaswa³

et al. 2019

Preprint

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Background The World Health Organization (WHO) End Tuberculosis Strategy calls for a 90% reduction in tuberculosis (TB) deaths and an 80% reduction in the incidence rate between 2015 and 2035. The 2018 WHO guidelines recognize the need for high-burden countries to implement outreach and treatment for the most vulnerable patients with latent TB infection (LTBI) in addition to treating patients with the active disease. The Democratic Republic of Congo (DR Congo) is among the countries bearing the highest burden of TB. However, additional data on LTBI is required for effective policy and strategy against the disease. Accordingly, the aim of this study is to estimate the prevalence of LTBI in HIV-infected adults in Kinshasa, DR Congo. Methods Over two hundred HIV-infected adult residents of Kinshasa were screened using both TUBERTEST®, which is a tuberculin skin test (TST), and QuantiFERON-TB Gold Plus® (QFT-Plus), which is an interferon gamma release assay. LTBI was screened using TST, QFT-Plus, and a combination of the two tests. The agreement between TST and QFT-Plus was calculated using Cohen’s Kappa coefficient. Results A total of 248 HIV-infected persons were enrolled in the study. Seventy-six patients (30.7% IC 95%: 25.2-36.7) had a positive TST result. Sixty-four (25.8% IC 95%: 20.7-31.6) had a positive QFT-Plus test result. The Kappa coefficient between TST and QFT-Plus was 0.225. Conclusions The prevalence of LTBI among HIV positive adults in Kinshasa was high considering either the positive TST or the positive QFT-Plus. However, the two tests had poor agreement.

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“…Our results are lower than those of the meta-analysis done by Ayubi et al [26] who found the prevalence of LTBI among HIV infected adults to be 59% (95% CI: 49, 69).…”

Section: Discussioncontrasting

confidence: 97%

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Kadima

Lutumba

Kaswa³

et al. 2019

Preprint

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“…This is relevant because infection with M.tb is thought to confer protection against incident disease from re-infection in HIV-uninfected individuals ( Andrews et al, 2012 ), and it may be that HIV increases susceptibility to M.tb infection. The protection conferred by previous infection is often assumed to be absent in PLHIV, but quantitative evidence is lacking due to the particular problems of TST as a test for infection in this population ( Ayubi et al, 2016 ). Ultimately, this means the relationship analyzed is between CD4 count and TB incidence either from primary progression, re-activation or re-infection.…”

Section: Discussionmentioning

confidence: 99%

CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis

Ellis

Martin

Dodd

2017

PeerJ

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BackgroundCD4 cell count in adults with human immunodeficiency virus (HIV) infection (PLHIV) not receiving antiretroviral therapy (ART) influences tuberculosis (TB) risk. Despite widespread use in models informing resource allocation, this relationship has not been systematically reviewed.MethodsWe systematically searched MEDLINE, Aidsinfo, Cochrane review database and Google Scholar for reports in English describing TB incidence stratified by updated CD4 cell count in cohorts of HIV-positive adults (age ≥15 years) not on ART (PROSPERO protocol no: CRD42016048888). Among inclusion criteria were: reporting precision for TB incidence, repeated CD4 measurements, and TB incidence reported for those not on ART or monotherapy. Study quality was assessed via the Newcastle-Ottawa tool for cohort studies. A Bayesian hierarchical model was fitted to estimate the pooled factor increase in TB incidence with respect to CD4 cell count decrement.ResultsA total of 1,555 distinct records were identified from which 164 full text articles were obtained. Common reasons for exclusion of full texts were: no valid TB incidence, no repeat CD4 measurements, and not reporting TB incidence by ART status. The seven studies included reported on 1,206 TB cases among 41,271 individuals, with a typical median follow-up of four years. Studies were generally rated as moderate or high quality. Our meta-analysis estimated a 1.43 (95% credible interval: 1.16–1.88)-fold increase in TB incidence per 100 cells per mm3 decrease in CD4 cell count.DiscussionOur analysis confirms previous estimates of exponential increase in TB incidence with declining CD4 cell count in adults, emphasizing the importance of early ART initiation to reduce TB risk in PLHIV.

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“…We did not construct pooled PABAK values because the lack of information on TST−/QFT-GIT−, TST−/QFT-GIT+, TST +/QFT-GIT−, TST+/QFT-GIT+ meant we were unable to derive that statistic. However, prevalence of disease and bias in measurements are known to have significant effect on κ estimate [35] as has been demonstrated in two previous meta-analyses [23,25]. We pooled κ estimates from countries with both high and low incidence of TB.…”

Section: Discussionmentioning

confidence: 99%

Comparison of QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for diagnosis of latent tuberculosis in haemodialysis (HD) patients: a meta-analysis ofκestimates

et al. 2017

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Diagnosis of latent tuberculosis infection (LTBI) is a concern in haemodialysis (HD) patients. Many studies have compared QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for detecting LTBI and reported the κ statistic of agreement between QFT-GIT and TST in HD patients. The present study aimed to systematically review this literature and conduct meta-analysis of individual studies that estimated the κ between QFT-GIT with TST among HD patients. All relevant published studies that were available as full-text were obtained by searching Medline (1950), Web of Sciences (1945), Scopus (1973) through May 2016. The κ was re-estimated from the individual studies and pooled using random effect meta-analysis. Subgroup analysis and meta-regression were applied to evaluate the effect of Bacillus Calmette-Guérin (BCG) vaccination, TST cut-off points, quality of studies, sample size and age on variation of κ estimate. Eight studies involving 901 HD patients were included in meta-analysis. The pooled κ estimate was 0·28 (I 2 = 18·4%, P = 0·239, 95% confidence intervals 0·22-0·34). The discordance of TST-/QFT-GIT+ was more than TST+/QFT-GIT-. History of BCG vaccination, TST cut-off points and age are related to variation of κ estimates. TST and QFT-GIT are not comparable in detecting LTBI in HD patients. The higher TST-/QFT-GIT+ ratio compared with TST+/QFT-GIT- ratio, may indicate the superiority of QFT-GIT over TST for detection LTBI in HD patients.

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The Clinical Usefulness of Tuberculin Skin Test versus Interferon-Gamma Release Assays for Diagnosis of Latent Tuberculosis in HIV Patients: A Meta-Analysis

Cited by 28 publications

References 39 publications

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis

Comparison of QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for diagnosis of latent tuberculosis in haemodialysis (HD) patients: a meta-analysis ofκestimates

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