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Tuberculin skin test and Q uanti FERON ‐ TB Gold I n‐tube T est for latent tuberculosis in T hai HIV ‐infected adults
Author(s) -
Khawcharoenporn Thana,
Apisarnthanarak Anucha,
Phetsuksiri Benjawan,
Rudeeaneksin Janisara,
Srisungngam Sopa,
Mundy Linda M.
Publication year - 2015
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12442
Subject(s) - medicine , tuberculosis , tuberculin , concordance , latent tuberculosis , immunology , tuberculosis diagnosis , gastroenterology , mycobacterium tuberculosis , pathology
Background and objective Limited data exist for the performance of Q uanti FERON ‐ TB Gold I n‐tube T est ( QFT‐IT ) in comparison to tuberculin skin test ( TST ) for detecting latent tuberculosis ( LTB ) in patients with human immunodeficiency virus ( HIV ) infection from tuberculosis ( TB )‐endemic A sia‐ P acific countries. Methods A cohort study of T hai HIV ‐infected patients without history of TB or LTB treatment was conducted from M arch 2012 through M arch 2013. Each patient underwent simultaneous TST and QFT‐IT . Results Among the 150 enrolled subjects, the median age was 40 years (range 17–65), 53% were male, and the median CD 4 count was 367 cells/μL (range 8–1290). Reactive TST and positive QFT‐IT were 16% and 13%, respectively, with low concordance between tests (kappa = 0.26); correlation between TST reaction size and level of interferon‐γ was moderate (r = 0.34). Independent factors associated with discordant results were long‐term smoking (adjusted odds ratio ( aOR ) 5.74; P = 0.002) for TST ‐reactive, QFT‐IT ‐negative subjects, and age greater than 52 years ( aOR 5.56; P = 0.02) and female gender ( aOR 4.40; P = 0.04) for TST non‐reactive, QFT‐IT ‐positive subjects. The level of agreement between both tests improved when using a TST cut‐off of ≥10 mm (kappa = 0.39). Conclusions I n our setting where QFT‐IT is available but has limited use due to cost, TST with a cut‐off of 10 mm for reactivity should be the initial LTB test. HIV ‐infected women and persons older than 52 years with non‐reactive TST and long‐term smokers with reactive TST may benefit from subsequent QFT‐IT .