Abstract
BackgroundThere is limited data on the effect of HIV status and CD4 counts on performance of Interferon-g Release assays (IGRAs) for diagnosis of latent tuberculosis infection (LTBI).MethodsA cross sectional study was conducted to assess the prevalence of and risk factors for a positive diagnostic test for LTBI, using tuberculin skin test (TST) and IGRAs among HIV-discordant couples in Zambia.ResultsA total of 596 subjects (298 couples) were enrolled. Median CD4 count among HIV positive persons was 388 cells/μl, (range 51-1330). HIV negative persons were more likely than their HIV positive partner, to have a positive diagnostic test for LTBI with TST (203 vs 128), QFT (171 vs 109) and TSPOT (156 vs. 109). On multivariate analysis, HIV negative status was an independent predictor for a positive QFT (OR = 2.22, 95% CI 1.42- 3.46) and TSPOT (OR = 1.79, 95% CI 1.16-2.77). Among HIV positive subjects a CD4 count ≥ 388 cells/μl was associated with a positive TST (OR = 1.76 95% CI 1.10-2.82) and QFT (OR = 1.71 95% CI 1.06-2.77) but not TSPOT (OR = 1.20 95% CI 0.74-1.94).ConclusionsPersons with HIV had significantly fewer positive diagnostic tests for LTBI with TST, QFT and TSPOT. Persons with a CD4 count < 388 cells/μl were less likely to have a positive TST or QFT, but not less likely to have a positive TSPOT. TSPOT may perform better than TST or QFT in HIV positive individuals.
Highlights
There is limited data on the effect of HIV status and CD4 counts on performance of Interferon-g Release assays (IGRAs) for diagnosis of latent tuberculosis infection (LTBI)
Among HIV-seropositive persons, a CD4 count ≥ 388 cells/μl was associated with a positive TST and QuantiFERON-TB Gold in Tube (QFT)
In conclusion, our study suggests that HIV positive status does decrease the sensitivity of TST, QFT and TSPOT
Summary
There is limited data on the effect of HIV status and CD4 counts on performance of Interferon-g Release assays (IGRAs) for diagnosis of latent tuberculosis infection (LTBI). HIV and tuberculosis (TB) are the leading causes of death among adults due to an infectious disease worldwide. It is estimated that > 13 million people are co-infected with HIV and Mycobacterium tuberculosis [1]. The World Health Organization (WHO) estimates that there are approximately 9.3 million new cases of active TB and nearly 2 million deaths due to the disease worldwide each year [2,3]. HIV infection is the most important risk factor for progression from latent tuberculosis infection (LTBI) to active TB [5,6]. In patients with HIV and LTBI, the
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