The Impact of HIV Infection and CD4 Cell Count on the Performance of an Interferon Gamma Release Assay in Patients with Pulmonary Tuberculosis

Aabye, Martine G.; Ravn, Pernille; PrayGod, George; Jeremiah, Kidola; Mugomela, Apolinary; Jepsen, Maria; Faurholt, Daniel; Range, Nyagosya; Friis, Henrik; Changalucha, John; Andersen, Aase B.
January 2009
PLoS ONE;2009, Vol. 4 Issue 1, p1
Academic Journal
Background: The performance of the tuberculosis specific Interferon Gamma Release Assays (IGRAs) has not been sufficiently documented in tuberculosis- and HIV-endemic settings. This study evaluated the sensitivity of the QuantiFERON TB-Gold In-Tube (QFT-IT) in patients with culture confirmed pulmonary tuberculosis (PTB) in a TB- and HIV-endemic population and the effect of HIV-infection and CD4 cell count on test performance. Methodology/Principal Findings: 161 patients with sputum culture confirmed PTB were subjected to HIV- and QFT-IT testing and measurement of CD4 cell count. The QFT-IT was positive in 74% (119/161; 95% CI: 67-81%). Sensitivity was higher in HIV-negative (75/93) than in HIV-positive (44/68) patients (81% vs. 65%, p = 0.02) and increased with CD4 cell count in HIV-positive patients (test for trend p = 0.03). 23 patients (14%) had an indeterminate result and this proportion decreased with increasing CD4 cell count in HIV-positive patients (test for trend p = 0.03). Low CD4 cell count (<300 cells/ml) did not account for all QFT-IT indeterminate nor all negative results. Sensitivity when excluding indeterminate results was 86% (95% CI: 81-92%) and did not differ between HIV-negative and HIV-positive patients (88 vs. 83%, p = 0.39). Conclusions/Significance: Sensitivity of the QFT-IT for diagnosing active PTB infection was reasonable when excluding indeterminate results and in HIV-negative patients. However, since the test missed more than 10% of patients, its potential as a rule-out test for active TB disease is limited. Furthermore, test performance is impaired by low CD4 cell count in HIVpositive patients and possibly by other factors as well in both HIV-positive and HIV-negative patients. This might limit the potential of the test in populations where HIV-infection is prevalent.


Related Articles

  • High Rates of Clinical and Subclinical Tuberculosis among HIV-Infected Ambulatory Subjects in Tanzania. Mtei, Lillian; Matee, Mecky; Herfort, Oliver; Bakari, Muhammad; Horsburgh, C. Robert; Waddell, Richard; Cole, Bernard F.; Vuola, Jenni M.; Tvaroha, Susan; Kreiswirth, Barry; Pallangyo, Kisali; von Reyn, C. Fordham // Clinical Infectious Diseases;5/15/2005, Vol. 40 Issue 10, p1500 

    Background. We sought to determine the prevalence of active tuberculosis among ambulatory HIV-infected persons in Tanzania with CD4 cell counts of ⩾200 cells/mm³ and a bacille Calmette-Guérin vaccination scat Methods. Subjects who volunteered for a tuberculosis booster vaccine trial...

  • Recent advances in our understanding of human host responses to tuberculosis. Schluger, Neil W. // Respiratory Research;2001, Vol. 2, p157 

    Tuberculosis remains one of the world's greatest public health challenges: 2 billion persons have latent infection, 8 million people develop active tuberculosis annually, and 2-3 million die. Recently, significant advances in our understanding of the human immune response against tuberculosis...

  • HIV Infection, Antiretroviral Therapy, and CD4+ Cell Count Distributions in African Populations. Williams, Brian G.; Korenromp, Eline L.; Gouws, Eleanor; Schmid, George P.; Auvert, Bertran; Dye, Christopher // Journal of Infectious Diseases;11/15/2006, Vol. 194 Issue 10, p1450 

    Background. The variability in CD4+ cell counts within and among human immunodeficiency virus (HIV)-positive and -negative African populations has not been explained but has important implications for understanding the incidence of HIV-related opportunistic infections, especially tuberculosis,...

  • RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS. de Paula MENEZES, Ralciane; BORGES, Aércio Sebastião; de ARAUJO, Lúcio Borges; dos Santos PEDROSO, Reginaldo; Von Dolinger de Brito RÖDER, Denise // Revista do Instituto de Medicina Tropical de Sao Paulo;Sep/Oct2015, Vol. 57 Issue 5, p413 

    The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. Aims: The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of...

  • How does CD4 count affect risk of non-AIDS diagnoses and death? Moore, Richard D. // Research Initiative/Treatment Action!;Autumn2008, Vol. 13 Issue 2, p27 

    The article focuses on the risk of non-AIDS morbidity and mortality in people with HIV infections. It mentions that cohort analysis confirmed the link between higher CD4 counts and a lower risk of death from non-AIDS cancer It adds that patients who begin treatment at higher CD4 counts have the...

  • A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV. Triplette, Matthew; Attia, Engi F.; Akgün, Kathleen M.; Soo Hoo, Guy W.; Freiberg, Matthew S.; Butt, Adeel A.; Wongtrakool, Cherry; Goetz, Matthew Bidwell; Brown, Sheldon T.; Graber, Christopher J.; Huang, Laurence; Crothers, Kristina // PLoS ONE;1/25/2017, Vol. 12 Issue 1, p1 

    Objectives: The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ to CD8+ T-lymphocyte (CD4/CD8) ratio may...

  • Clearance to market azithromycin as prevention for a common OI in advanced AIDS.  // AIDS Patient Care & STDs;Oct96, Vol. 10 Issue 5, p313 

    Reports on the use of Food and Drug Administration (FDA)-approved azithromycin (Zithromax) for the prevention of disseminated Mycobacterium avium complex (MAC) disease in advanced HIV infection. Discussion of MAC disease; Recommended dosage; Mild to moderate side effects; Offered at lower cost.

  • Immune restoration disease and changes in CD4+ T-cell count in HIV- infected patients during highly active antiretroviral therapy at Zewditu memorial hospital, Addis Ababa, Ethiopia. Huruy, Kahsay; Kassu, Afework; Mulu, Andargachew; Wondie, Yemataw // AIDS Research & Therapy;2010, Vol. 7, p46 

    Background: Highly active antiretroviral therapy (HAART) improves the immune function and decreases morbidity, mortality and opportunistic infections (OIs) in HIV-infected patients. However, since the use of HAART, immune restoration disease (IRD) has been described in association with many OIs....

  • Immune reconstitution inflammatory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection: a case report. Jiun-Nong Lin; Chung-Hsu Lai; Yen-Hsu Chen; Lin-Li Chang; Susan Shin-Jung Lee; Hsi-Hsun Lin // BMC Infectious Diseases;2010, Vol. 10 Issue 1, p321 

    Background: Patients with human immunodeficiency virus (HIV) infection are at risk for Mycobacterium tuberculosis (TB) coinfection. The advent of antiretroviral therapy restores immunity in HIV-infected patients, but predisposes patients to immune reconstitution inflammatory syndrome (IRIS)....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics