Diagnostic value of interferon-γ release assay in HIV-infected individuals complicated with active tuberculosis: a systematic review and meta-analysis.

Yiyun Ma,Yuni Xu,Xiaojuan Chen,Xiaoqiang Cao,Yeteng Zhong

doi:10.1017/s0950268821001953

Abstract

Although the interferon-γ release assay (IGRA) has become a common diagnostic method for tuberculosis, its value in the diagnosis of tuberculosis in human immunodeficiency virus (HIV) seropositive patients remains controversial. Therefore, this systematically reviews the data for exploring the diagnostic value of IGRA in HIV-infected individuals complicated with active tuberculosis, aiming to provide a clinical basis for future clinical diagnosis of the disease. Relevant studies on IGRA for diagnosing tuberculosis in HIV-infected patients were comprehensively collected from Excerpta Medica Database (EMBASE), Medline, Cochrane Library, Chinese Sci-tech Periodical Full-text Database, Chinese Periodical Full-text Database, China National Knowledge Infrastructure (CNKI) and China Wanfang Data up to July 2020. Subsequently, Stata 15.0, an integrated statistical software, was used to analyse the sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to create receiver operator characteristic (ROC) curves. A total of 18 high-quality articles were selected, including 20 studies, 11 of which were related to QuantiFERON-TB Gold In-Tube (QFT-GIT) and nine to T-SPOT.TB. The meta-analysis indicated that the pooled sensitivity = 0.75 (95% CI 0.63-0.85), the pooled specificity = 0.82 (95% CI 0.66-0.92), PLR = 4.25 (95% CI 1.97-9.18), NLR = 0.30 (95% CI 0.18-0.50), DOR = 14.21 (95% CI 4.38-46.09) and the area under summary ROC curve was 0.85 (95% CI 0.81-0.88). IGRA has a good diagnostic value and therefore can aid in the preliminary screening of active tuberculosis in HIV-infected individuals. Its diagnostic effectiveness can be improved by modifying and optimizing the assay design.

Highlights

Human immunodeficiency virus (HIV) infection causes significant damage to the immune function of patients, especially destroying T cells, leading to a significant increase in the incidence of various diseases [1]
The meta-analysis indicated that the pooled sensitivity = 0.75, the pooled specificity = 0.82, positive likelihood ratio (PLR) = 4.25, negative likelihood ratio (NLR) = 0.30, diagnostic odds ratio (DOR) = 14.21 and the area under summary receiver operator characteristic (ROC) curve was 0.85
By using meta-analysis, this study systematically evaluated the published trials on IGRA for diagnosing tuberculosis infection in HIV-infected patients, objectively assessing the clinical diagnostic value of IGRA, and providing a reference for its clinical application

Summary

Introduction

Human immunodeficiency virus (HIV) infection causes significant damage to the immune function of patients, especially destroying T cells, leading to a significant increase in the incidence of various diseases [1]. Two types of IGRA, QuantiFERON-TB Gold In-Tube (QFT-GIT) approved by FDA of USA and T-SPOT.TB used in Europe, are currently used for the detection of tuberculosis [6, 7]. These two assays are based on the early secretory antigenic target 6 (ESAT-6) secreted by Mtb, and the good immunogenicity of culture filtrate protein-10 (CFP-10). ESAT-6 and CFP-10 are endemic to Mtb, but absent in Bacillus Calmette-Guerin (BCG) and most environmental mycobacteria They can induce the secretion of IFN-γ by lymphocytes in tuberculosis patients. These T cells producing IFN-γ can be detected by sensitive enzyme-linked immunosorbent assay (ELISA) or ELISPOT

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Results

Conclusion