Interferon release does not add discriminatory value to smear-negative HIV-tuberculosis algorithms
- 30 June 2011
- journal article
- research article
- Published by European Respiratory Society (ERS) in European Respiratory Journal
- Vol. 39 (1), 163-171
- https://doi.org/10.1183/09031936.00058911
Abstract
Clinical algorithms for evaluating HIV-infected individuals for tuberculosis (TB) prior to isoniazid preventive therapy (IPT) perform poorly, and interferon-γ release assays (IGRAs) have moderate accuracy for active TB. It is unclear whether, when used as adjunct tests, IGRAs add any clinical discriminatory value for active TB diagnosis in the pre-IPT assessment. 779 sputum smear-negative HIV-infected persons, established on or about to commence combined antiretroviral therapy (ART), were screened for TB prior to IPT. Stepwise multivariable logistic regression was used to develop clinical prediction models. The discriminatory ability was assessed by receiver operator characteristic area under the curve (AUC). QuantiFERON®-TB Gold in-tube (QFT-GIT) was evaluated. The prevalence of smear-negative TB by culture was 6.4% (95% CI 4.9–8.4%). Used alone, QFT-GIT and the tuberculin skin test (TST) had comparable performance; the post-test probability of disease based on single negative tests was 3–4%. In a multivariable model, the QFT-GIT test did not improve the ability of a clinical algorithm, which included not taking ART, weight 3, to discriminate smear-negative culture-positive and -negative TB (72% to 74%; AUC comparison p=0.33). The TST marginally improved the discriminatory ability of the clinical model (to 77%, AUC comparison p=0.04). QFT-GIT does not improve the discriminatory ability of current TB screening clinical algorithms used to evaluate HIV-infected individuals for TB ahead of preventive therapy. Evaluation of new TB diagnostics for clinical relevance should follow a multivariable process that goes beyond test accuracy.Keywords
This publication has 47 references indexed in Scilit:
- Interferon-Gamma Release Assays for the Diagnosis of Latent Tuberculosis Infection in HIV-Infected Individuals: A Systematic Review and Meta-AnalysisJAIDS Journal of Acquired Immune Deficiency Syndromes, 2011
- Intensive Tuberculosis Screening for HIV‐Infected Patients Starting Antiretroviral Therapy in Durban, South AfricaClinical Infectious Diseases, 2010
- An interferon-inducible neutrophil-driven blood transcriptional signature in human tuberculosisNature, 2010
- Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infectionBMC Infectious Diseases, 2010
- Yield of HIV-associated tuberculosis during intensified case finding in resource-limited settings: a systematic review and meta-analysisThe Lancet Infectious Diseases, 2010
- An Algorithm for Tuberculosis Screening and Diagnosis in People with HIVNew England Journal of Medicine, 2010
- Evaluation of Quantitative IFN-γ Response for Risk Stratification of Active Tuberculosis SuspectsAmerican Journal of Respiratory and Critical Care Medicine, 2010
- Assessing the Performance of Prediction ModelsEpidemiology, 2010
- Host markers in Quantiferon supernatants differentiate active TB from latent TB infection: preliminary reportBMC Pulmonary Medicine, 2009
- Burden of tuberculosis in an antiretroviral treatment programme in sub-Saharan Africa: impact on treatment outcomes and implications for tuberculosis controlAIDS, 2006