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Published ahead of print on January 11, 2007, doi:10.1164/rccm.200608-1088OC
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American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 737-742, (2007)
© 2007 American Thoracic Society
doi: 10.1164/rccm.200608-1088OC

Original Article

Comparison of an Interferon-{gamma} Release Assay with Tuberculin Skin Testing in HIV-infected Individuals

Annie F. Luetkemeyer1,2, Edwin D. Charlebois2, Laura L. Flores3, David R. Bangsberg1,4, Steven G. Deeks1, Jeffrey N. Martin1 and Diane V. Havlir1

1 HIV/AIDS Division, San Francisco General Hospital, University of California at San Francisco, San Francisco, California; 2 Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California; 3 Division of Pulmonary and Critical Care, San Francisco General Hospital, University of California at San Francisco, San Francisco, California; and 4 Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, University of California at San Francisco, San Francisco, California

Correspondence and requests for reprints should be addressed to Annie Luetkemeyer, M.D., HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, Box 0874, Building 80, 995 Potrero Avenue, San Francisco, CA 94110. E-mail: aluetkemeyer{at}php.ucsf.edu

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. Subjects with a CD4+ count of less than 100 cells/mm3 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.

Key Words: latent tuberculosis infection • human immunodeficiency virus • QuantiFERON • interferon-{gamma} assay • tuberculin skin test


AT A GLANCE COMMENTARY

Scientific Knowledge on the Subject
Although interferon-{gamma} assays are promising alternatives to the tuberculin skin test, there are limited data on the performance of these diagnostics in the HIV-infected population, in whom latent tuberculosis infection diagnosis and treatment is a priority.

What This Study Adds to the Field
Concordance between IFN-{gamma} release assays in HIV-infected subjects is high, but agreement between positive results with different tests is relatively low.

 



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