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Published ahead of print on January 11, 2007, doi:10.1164/rccm.200608-1088OC

Am. J. Respir. Crit. Care Med., Volume 175, Number 7, April 2007, 737-742

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Submitted on August 3, 2006
Accepted on January 11, 2007

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

Annie F Luetkemeyer1*, Edwin D Charlebois2, Laura L Flores3, David R Bangsberg4, Steven G Deeks5, Jeffrey N Martin5, and Diane V Havlir5

1 HIV/AIDS Division, San Francisco General Hospital, University of California at San Francisco, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA, USA, 2 Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA, USA, 3 Division of Pulmonary and Critical Care, San Francisco Hospital, University of California at San Francisco, San Francisco, CA, USA, 4 HIV/AIDS Division, San Francisco General Hospital, University of California at San Francisco, San Francisco, CA, USA; Epidemiology and Prevention Interventions Center, University of California at San Francisco, San Francisco, CA, USA, 5 HIV/AIDS Division, San Francisco General Hospital, University of California at San Francisco, San Francisco, CA, USA

* To whom correspondence should be addressed. E-mail: aluetkemeyer{at}php.ucsf.edu.

Rationale: Although interferon-gamma (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: 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 M. 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 tests 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 < 100 cells/mm3 had a RR of an indeterminate result of 4.24 (95% CI 1.55- 11.61, p= 0.003) compared to those with CD4+≥ 100. 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




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