QuantiFERON conversion following tuberculin administration is common in HIV infection and relates to baseline response

BMC Infectious Diseases

Research Article

Rene Goliath¹  Hanif Esmail²  Robert J. Wilkinson³  Friedrich Thienemann⁴  Tolu Oni⁵  Katalin A. Wilkinson⁶ 

[1] Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;Department of Medicine, Imperial College London, London, UK;Nuffield Division of Clinical and Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK;Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;Department of Medicine, Imperial College London, London, UK;The Francis Crick Institute, London, UK;Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;Department of Medicine, University of Cape Town, Cape Town, South Africa;Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa;Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;The Francis Crick Institute, London, UK;

关键词: Latent tuberculosis;    HIV;    QuantiFERON®-TB Gold in-tube;    Diagnostics;    Interferon Gamma Release Assay;   

DOI  :  10.1186/s12879-016-1875-6

 received in 2016-04-12, accepted in 2016-09-27,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHIV-1 infection impairs tuberculosis (TB) specific immune responses affecting the diagnosis of latent TB. We aimed to (1) determine the proportion of HIV-1-infected adults with a negative QuantiFERON®-TB Gold in-tube (QFT-GIT) and Tuberculin skin testing (TST) that convert to QFT-GIT positive following TST, and (2) evaluate the relationship between conversion and baseline QFT-GIT results.MethodsHIV-1 infected adults being screened for a TB vaccine study in South Africa underwent QFT-GIT followed by TST. As per protocol, QFT-GIT was repeated if randomization was delayed allowing for evaluation of TST boosting in a proportion of participants.ResultsOf the 22 HIV-1 infected, TST and QFT-GIT negative adults (median CD4 477/mm3 IQR 439–621) who had QFT-GIT repeated after median 62 days (IQR 49–70), 40.9 % (95 % CI 18.6–63.2 %) converted. Converters had a significantly greater increase in the background subtracted TB antigen response (TBAg-Nil – all units IU/mL) following TST, 0.82 (IQR 0.39–1.28) vs 0.03 (IQR −0.05–0.06), p = 0.0001. Those who converted also had a significantly higher baseline TBAg-Nil 0.21(IQR 0.17–0.26) vs 0.02(IQR 0.01–0.07), p = 0.002. Converters did not differ with regard to CD4 count or ART status. ROC analysis showed a baseline cut off of 0.15 correctly classified 86.4 % of converters with 88.9 % sensitivity.ConclusionsOur findings support the possibility that there are 2 distinct groups in an HIV-1 infected population with negative QFT-GIT and TST; a true negative group and a group showing evidence of a weak Mtb specific immune response that boosts significantly following TST resulting in conversion of the test result that may represent false negatives. Further evaluation of whether a lower cut off may improve sensitivity of QFT-GIT in this population is warranted.

【 授权许可】

CC BY   
© The Author(s). 2016