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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The impact of HIV infection and CD4 cell count on the performance of an interferon gamma release assay in patients with pulmonary tuberculosis
PLoS ONE, Volume 4, No. 1, Article e4220, Year 2009
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Description
Background: The performance of the tuberculosis specific Interferon Gamma Release Assays (IGRAs) has not been sufficiently documented in tuberculosis- and HIV-endemic settings. This study evaluated the sensitivity of the QuantiFERON TB-Gold In-Tube (QFT-IT) in patients with culture confirmed pulmonary tuberculosis (PTB) in a TB- and HIV-endemic population and the effect of HIV-infection and CD4 cell count on test performance. Methodology/Principal Findings: 161 patients with sputum culture confirmed PTB were subjected to HIV- and QFT-IT testing and measurement of CD4 cell count. The QFT-IT was positive in 74% (119/161; 95% CI: 67-81%). Sensitivity was higher in HIV-negative (75/93) than in HIV-positive (44/68) patients (81% vs. 65%, p = 0.02) and increased with CD4 cell count in HIV-positive patients (test for trend p = 0.03). 23 patients (14%) had an indeterminate result and this proportion decreased with increasing CD4 cell count in HIV-positive patients (test for trend p = 0.03). Low CD4 cell count (<300 cells/μl) did not account for all QFT-IT indeterminate nor all negative results. Sensitivity when excluding indeterminate results was 86% (95% CI: 81-92%) and did not differ between HIV-negative and HIV-positive patients (88 vs. 83%, p = 0.39). Conclusions/Significance: Sensitivity of the QFT-IT for diagnosing active PTB infection was reasonable when excluding indeterminate results and in HIV-negative patients. However, since the test missed more than 10% of patients, its potential as a rule-out test for active TB disease is limited. Furthermore, test performance is impaired by low CD4 cell count in HIV-positive patients and possibly by other factors as well in both HIV-positive and HIV-negative patients. This might limit the potential of the test in populations where HIV-infection is prevalent. © 2009 Aabye et al.
Authors & Co-Authors
Aabye, Martine Grosos
Denmark, Copenhagen
Københavns Universitet
Ravn, Pernille
Denmark, Copenhagen
Københavns Universitet
PrayGod, George
Tanzania, Tanga
National Institute for Medical Research Tanga
Jeremiah, Kidola
Tanzania, Tanga
National Institute for Medical Research Tanga
Mugomela, A.
Tanzania, Mwanza
Bugando Medical Centre
Jepsen, Maria
Denmark, Frederiksberg
Det Natur- og Biovidenskabelige Fakultet
Faurholt, Daniel
Denmark, Frederiksberg
Det Natur- og Biovidenskabelige Fakultet
Range, Nyagosya Segere
Tanzania, Tanga
National Institute for Medical Research Tanga
Friis, Henrik M.U.
Denmark, Frederiksberg
Det Natur- og Biovidenskabelige Fakultet
Changalucha, John M.
Tanzania, Tanga
National Institute for Medical Research Tanga
Andersen, Aase Bengaard
Denmark, Copenhagen
Københavns Universitet
Statistics
Citations: 100
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0004220
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study