Author(s): Santin M, Muoz L, Rigau D
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Abstract BACKGROUND: Despite the widespread use of interferon-γ release assays (IGRAs), their role in diagnosing tuberculosis and targeting preventive therapy in HIV-infected patients remains unclear. We conducted a comprehensive systematic review to contribute to the evidence-based practice in HIV-infected people. METHODOLOGY/PRINCIPAL FINDINGS: We searched MEDLINE, Cochrane, and Biomedicine databases to identify articles published between January 2005 and July 2011 that assessed QuantiFERON®-TB Gold In-Tube (QFT-GIT) and T-SPOT®.TB (T-SPOT.TB) in HIV-infected adults. We assessed their accuracy for the diagnosis of tuberculosis and incident active tuberculosis, and the proportion of indeterminate results. The search identified 38 evaluable studies covering a total of 6514 HIV-infected participants. The pooled sensitivity and specificity for tuberculosis were 61\% and 72\% for QFT-GIT, and 65\% and 70\% for T-SPOT.TB. The cumulative incidence of subsequent active tuberculosis was 8.3\% for QFT-GIT and 10\% for T-SPOT.TB in patients tested positive (one study each), and 0\% for QFT-GIT (two studies) and T-SPOT.TB (one study) respectively in those tested negative. Pooled indeterminate rates were 8.2\% for QFT-GIT and 5.9\% for T-SPOT.TB. Rates were higher in high burden settings (12.0\% for QFT-GIT and 7.7\% for T-SPOT.TB) than in low-intermediate burden settings (3.9\% for QFT-GIT and 4.3\% for T-SPOT.TB). They were also higher in patients with CD4(+) T-cell count <200 (11.6\% for QFT-GIT and 11.4\% for T-SPOT.TB) than in those with CD4(+) T-cell count ≥ 200 (3.1\% for QFT-GIT and 7.9\% for T-SPOT.TB). CONCLUSIONS/SIGNIFICANCE: IGRAs have suboptimal accuracy for confirming or ruling out active tuberculosis disease in HIV-infected adults. While their predictive value for incident active tuberculosis is modest, a negative QFT-GIT implies a very low short- to medium-term risk. Identifying the factors associated with indeterminate results will help to optimize the use of IGRAs in clinical practice, particularly in resource-limited countries with a high prevalence of HIV-coinfection.
This article was published in PLoS One
and referenced in Journal of Antivirals & Antiretrovirals