TITLE

Detection and Prediction of Active Tuberculosis Disease by a Whole-Blood Interferon-γ Release Assay in HIV-1-Infected Individuals

AUTHOR(S)
Aichelburg, Maximilian C.; Rieger, Armin; Breitenecker, Florian; Pfistershammer, Katharina; Tittes, Julia; Eltz, Stephanie; Aichelburg, Alexander C.; Stingl, Georg; Makristathis, Athanasios; Kohrgruber, Norbert
PUB. DATE
April 2009
SOURCE
Clinical Infectious Diseases;4/1/2009, Vol. 48 Issue 7, p954
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background. The sensitivity of whole-blood interferon-g release assays to detect or predict active tuberculosis in individuals infected with human immunodeficiency virus type 1 (HIV-1) has as yet not been determined. Methods. In this prospective, longitudinal, single-center study, 830 HIV-1-infected patients underwent testing with the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay. Clinical screening for active tuberculosis was performed at least every 3 months for a median follow-up time of 19 months. Results. At baseline, the QFT-GIT assay yielded positive or indeterminate results in 44 (5.3%) and 47 (5.7%) of the 830 patients, respectively. A positive QFT-GIT assay result occurred at significantly higher frequencies among black individuals than among white individuals (odds ratio, 4.84; 95% confidence interval, 2.25-9.97; P < .001), among patients from Africa than among patients from Austria (odds ratio, 6.57; 95% confidence interval, 2.99- 14.25; P < .001), and among patients from high-prevalence countries than among patients from low-prevalence countries (odds ratio, 5.86; 95% confidence interval, 2.41-13.44; P < .001). In patients with indeterminate QFTGIT assay results, both median actual and nadir CD4+ T cell counts were significantly lower than in patients with interpretable QFT-GIT assay results (P < .001). At the time of baseline QFT-GIT screening, active tuberculosis was found in 7 (15.9%) of 44 individuals with a positive result and in 1 (0.1%) of 739 patients with a negative result. During the follow-up period, however, progression to active tuberculosis occurred exclusively in patients with a positive QFT-GIT assay result, at a rate of 8.1% (3 of 37 patients; P < .001). Collectively, the sensitivity of the QFT-GIT assay for active tuberculosis was 90.9% (95% confidence interval, 62.3%-98.4%). Conclusions. Our results suggest that the QFT-GIT assay may be a sensitive tool for the detection and prediction of active tuberculosis in HIV-1-infected individuals.
ACCESSION #
36906113

 

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