Risk factors associated with positive QuantiFERON-TB Gold In-Tube and tuberculin skin tests results in Zambia and South Africa

Kwame Shanaube, James Hargreaves, Katherine Fielding, Ab Schaap, Katherine-Anne Lawrence, Bernadette Hensen, Charalambos Sismanidis, Angela Menezes, Nulda Beyers, Helen Ayles, Peter Godfrey-Faussett

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Abstract

INTRODUCTION: The utility of T-cell based interferon-gamma release assays for the diagnosis of latent tuberculosis infection remains unclear in settings with a high burden of tuberculosis.

OBJECTIVES: To determine risk factors associated with positive QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) results and the level of agreement between the tests; to explore the hypotheses that positivity in QFT-GIT is more related to recent infection and less affected by HIV than the TST.

METHODS: Adult household contacts of tuberculosis patients were invited to participate in a cross-sectional study across 24 communities in Zambia and South Africa. HIV, QFT-GIT and TST tests were done. A questionnaire was used to assess risk factors.

RESULTS: A total of 2,220 contacts were seen. 1,803 individuals had interpretable results for both tests, 1,147 (63.6%) were QFT-GIT positive while 725 (40.2%) were TST positive. Agreement between the tests was low (kappa = 0.24). QFT-GIT and TST results were associated with increasing age (adjusted OR [aOR] for each 10 year increase for QFT-GIT 1.15; 95% CI: 1.06-1.25, and for TST aOR: 1.10; 95% CI 1.01-1.20). HIV positivity was less common among those with positive results on QFT-GIT (aOR: 0.51; 95% CI: 0.39-0.67) and TST (aOR: 0.61; 95% CI: 0.46-0.82). Smear positivity of the index case was associated with QFT-GIT (aOR: 1.25; 95% CI: 0.90-1.74) and TST (aOR: 1.39; 95% CI: 0.98-1.98) results. We found little evidence in our data to support our hypotheses.

CONCLUSION: QFT-GIT may not be more sensitive than the TST to detect risk factors associated with tuberculous infection. We found little evidence to support the hypotheses that positivity in QFT-GIT is more related to recent infection and less affected by HIV than the TST.

Original languageEnglish
Article numbere18206
JournalPLoS ONE
Volume6
Issue number4
Number of pages11
ISSN1932-6203
DOIs
Publication statusPublished - 2011

Keywords

  • Adolescent
  • Adult
  • Aged
  • Data Collection
  • Female
  • HIV Infections/diagnosis
  • Housing
  • Humans
  • Interferon-gamma/metabolism
  • Latent Tuberculosis/diagnosis
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis/pathogenicity
  • Risk Factors
  • South Africa
  • Tuberculin Test
  • Young Adult
  • Zambia

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