Effect of HIV-1 infection on T-Cell-based and skin test detection of tuberculosis infection

Hdl Handle:
http://hdl.handle.net/10144/116356
Title:
Effect of HIV-1 infection on T-Cell-based and skin test detection of tuberculosis infection
Authors:
Rangaka, M X; Wilkinson, K A; Seldon, R; Van Cutsem, G; Meintjes, G A; Morroni, C; Mouton, P; Diwakar, L; Connell, T G; Maartens, G; Wilkinson, R J
Journal:
American Journal of Respiratory and Critical Care Medicine
Abstract:
RATIONALE: Two forms of the IFN-gamma release assay (IFNGRA) to detect tuberculosis infection are available, but neither has been evaluated in comparable HIV-infected and uninfected persons in a high tuberculosis incidence environment. OBJECTIVE: To compare the ability of the T-SPOT.TB (Oxford Immunotec, Abingdon, UK), QuantiFERON-TB Gold (Cellestis, Melbourne, Australia), and Mantoux tests to identify latent tuberculosis in HIV-infected and uninfected persons. METHODS: A cross-sectional study of 160 healthy adults without active tuberculosis attending a voluntary counseling and testing center for HIV infection in Khayelitsha, a deprived urban South African community with an HIV antenatal seroprevalence of 33% and a tuberculosis incidence of 1,612 per 100,000. MEASUREMENTS AND MAIN RESULTS: One hundred and sixty (74 HIV(+) and 86 HIV(-)) persons were enrolled. A lower proportion of Mantoux results was positive in HIV-infected subjects compared with HIV-uninfected subjects (p < 0.01). By contrast, the proportion of positive IFNGRAs was not significantly different in HIV-infected persons for the T-SPOT.TB test (52 vs. 59%; p = 0.41) or the QuantiFERON-TB Gold test (43 and 46%; p = 0.89). Fair agreement between the Mantoux test (5- and 10-mm cutoffs) and the IFNGRA was seen in HIV-infected people (kappa = 0.52-0.6). By contrast, poor agreement between the Mantoux and QuantiFERON-TB Gold tests was observed in the HIV-uninfected group (kappa = 0.07-0.30, depending on the Mantoux cutoff). The pattern was similar for T-SPOT.TB (kappa = 0.18-0.24). Interpretation: IFNGRA sensitivity appears relatively unimpaired by moderately advanced HIV infection. However, agreement between the tests and with the Mantoux test varied from poor to fair. This highlights the need for prospective studies to determine which test may predict the subsequent risk of tuberculosis.
Affiliation:
Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Trust Center for Research in Clinical Tropical Medicine and Department of Infectious Diseases Epidemiology, Wright Fleming Institute, Imperial College London, London, United Kingdom; Medicins sans Frontie`res South Africa, Khayelitsha Site B Community Health Clinic, Khayelitsha Township, South Africa; School of Public Health, University of Cape Town, Cape Town, South Africa; Division of Pharmacology, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
Issue Date:
7-Dec-2007
URI:
http://hdl.handle.net/10144/116356
DOI:
10.1164/rccm.200610-1439OC
PubMed ID:
17158278
Additional Links:
http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17158278
Type:
Article
Language:
en
ISSN:
1073-449X
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorRangaka, M Xen
dc.contributor.authorWilkinson, K Aen
dc.contributor.authorSeldon, Ren
dc.contributor.authorVan Cutsem, Gen
dc.contributor.authorMeintjes, G Aen
dc.contributor.authorMorroni, Cen
dc.contributor.authorMouton, Pen
dc.contributor.authorDiwakar, Len
dc.contributor.authorConnell, T Gen
dc.contributor.authorMaartens, Gen
dc.contributor.authorWilkinson, R Jen
dc.date.accessioned2010-11-25T20:22:37Z-
dc.date.available2010-11-25T20:22:37Z-
dc.date.issued2007-12-07-
dc.identifier.citationAm. J. Respir. Crit. Care Med. 2007;175(5):514-20en
dc.identifier.issn1073-449X-
dc.identifier.pmid17158278-
dc.identifier.doi10.1164/rccm.200610-1439OC-
dc.identifier.urihttp://hdl.handle.net/10144/116356-
dc.description.abstractRATIONALE: Two forms of the IFN-gamma release assay (IFNGRA) to detect tuberculosis infection are available, but neither has been evaluated in comparable HIV-infected and uninfected persons in a high tuberculosis incidence environment. OBJECTIVE: To compare the ability of the T-SPOT.TB (Oxford Immunotec, Abingdon, UK), QuantiFERON-TB Gold (Cellestis, Melbourne, Australia), and Mantoux tests to identify latent tuberculosis in HIV-infected and uninfected persons. METHODS: A cross-sectional study of 160 healthy adults without active tuberculosis attending a voluntary counseling and testing center for HIV infection in Khayelitsha, a deprived urban South African community with an HIV antenatal seroprevalence of 33% and a tuberculosis incidence of 1,612 per 100,000. MEASUREMENTS AND MAIN RESULTS: One hundred and sixty (74 HIV(+) and 86 HIV(-)) persons were enrolled. A lower proportion of Mantoux results was positive in HIV-infected subjects compared with HIV-uninfected subjects (p < 0.01). By contrast, the proportion of positive IFNGRAs was not significantly different in HIV-infected persons for the T-SPOT.TB test (52 vs. 59%; p = 0.41) or the QuantiFERON-TB Gold test (43 and 46%; p = 0.89). Fair agreement between the Mantoux test (5- and 10-mm cutoffs) and the IFNGRA was seen in HIV-infected people (kappa = 0.52-0.6). By contrast, poor agreement between the Mantoux and QuantiFERON-TB Gold tests was observed in the HIV-uninfected group (kappa = 0.07-0.30, depending on the Mantoux cutoff). The pattern was similar for T-SPOT.TB (kappa = 0.18-0.24). Interpretation: IFNGRA sensitivity appears relatively unimpaired by moderately advanced HIV infection. However, agreement between the tests and with the Mantoux test varied from poor to fair. This highlights the need for prospective studies to determine which test may predict the subsequent risk of tuberculosis.en
dc.language.isoenen
dc.relation.urlhttp://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17158278en
dc.rightsArchived with thanks to American Journal of Respiratory and Critical Care Medicineen
dc.subject.meshAdulten
dc.subject.meshCD4 Lymphocyte Counten
dc.subject.meshCD4-Positive T-Lymphocytesen
dc.subject.meshCross-Sectional Studiesen
dc.subject.meshDiagnosis, Differentialen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHIV Antigensen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV-1en
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshReproducibility of Resultsen
dc.subject.meshTuberculin Testen
dc.subject.meshTuberculosis, Pulmonaryen
dc.subject.meshUrban Populationen
dc.titleEffect of HIV-1 infection on T-Cell-based and skin test detection of tuberculosis infectionen
dc.typeArticleen
dc.contributor.departmentInstitute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Trust Center for Research in Clinical Tropical Medicine and Department of Infectious Diseases Epidemiology, Wright Fleming Institute, Imperial College London, London, United Kingdom; Medicins sans Frontie`res South Africa, Khayelitsha Site B Community Health Clinic, Khayelitsha Township, South Africa; School of Public Health, University of Cape Town, Cape Town, South Africa; Division of Pharmacology, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africaen
dc.identifier.journalAmerican Journal of Respiratory and Critical Care Medicineen

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