Journal Article

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

Maximilian C. Aichelburg, Armin Rieger, Florian Breitenecker, Katharina Pfistershammer, Julia Tittes, Stephanie Eltz, Alexander C. Aichelburg, Georg Stingl, Athanasios Makristathis and Norbert Kohrgruber

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 7, pages 954-962
Published in print April 2009 | ISSN: 1058-4838
Published online April 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/597351
Detection and Prediction of Active Tuberculosis Disease by a Whole-Blood Interferon-γ Release Assay in HIV-1–Infected Individuals

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Background. The sensitivity of whole-blood interferon-γ 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 QFT-GIT 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.

Journal Article.  4630 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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