Interferon-γ release assays for the diagnosis of tuberculosis and tuberculosis infection in HIV-infected adults : A systematic review and meta-analysis
Santin, Miguel (Institut d'Investigació Biomèdica de Bellvitge)
Muñoz, Laura (Institut d'Investigació Biomèdica de Bellvitge)
Rigau, David (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2012
Resum:	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. © 2012 Santin et al.
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Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 7 Núm. 3 (may 2012) , p. e32482, ISSN 1932-6203

DOI: 10.1371/journal.pone.0032482
PMID: 22403663

15 p, 1.8 MB

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