Added value of QuantiFERON TB-gold in-tube for detecting latent tuberculosis infection among persons living with HIV/AIDS.

ABSTRACT

OBJECTIVE: To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. METHODS: Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. RESULTS: Median CD4-cell count was 477.5 cells/mm(3); 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI 3.6%-9.3%) had LTBI, of whom 4 (1.3%, 95% CI 0.04%-2.63%) had only a positive TST, 8 (2.7%, 95% CI 0.8%-4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI 0.4%-3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). CONCLUSIONS: The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.