Good Agreement between an Interferon Gamma Release Assay and Tuberculin Skin Tests in Testing for Latent Tuberculosis Infection among HIV-Infected Patients in Indonesia

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Abstract

Background

Latent tuberculosis infection is a condition where there is a persistent immune response to Mycobacterium tuberculosis without clinical manifestations of tuberculosis. Currently, there is no gold standard to diagnose latent tuberculosis infection. The tuberculin skin test and interferon-gamma release assay are currently used to diagnose latent tuberculosis infection. However, studies have shown inconsistencies regarding the level of agreement between these tests in different settings. In this study, we aimed to evaluate the agreement between these two tests for diagnosing latent tuberculosis infection in human immunodeficiency virus (HIV)-infected individuals.

Methods

We screened HIV patients with no clinical symptoms of tuberculosis, a normal chest X-ray, and no history of tuberculosis or use of antituberculous drugs. Participants were tested with tuberculin skin test (TST) and T-SPOT.TB (an interferon gamma release assay) simultaneously. Participants' HIV stage was determined by measuring the level of CD4+ T-lymphocytes. Tuberculosis status was confirmed by sputum examination using GeneXpert. The level of agreement between the TST and T-SPOT.TB results was measured using Cohen's κ coefficient.

Results

Of the 112 participants, 20 had a positive T-SPOT.TB test result, and 21 had a positive TST result. The TST and T-SPOT.TB test results showed a high level of agreement (κ = 0.648, P < 0.001). Performance of the tests did not vary with CD4+ level. However, in participants with CD4+ < 200 cells/mm ³, T-SPOT.TB detected more latent tuberculosis infections than the TST.

Conclusion

There was good agreement between the TST and T-SPOT.TB results of latent tuberculosis infection in participants. TST is the preferred test for diagnosing latent tuberculosis infection in HIV-infected patients, especially in resource-limited settings, because it is simple and cost-effective. However, T-SPOT.TB may be useful to rule out latent tuberculosis infection in patients with severe immunodeficiency.

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Tuberculosis and HIV Co-Infection

Tomasz Pawłowski, Marianne Jansson, Markus Sköld … (2012)

Tuberculosis (TB) and HIV co-infections place an immense burden on health care systems and pose particular diagnostic and therapeutic challenges. Infection with HIV is the most powerful known risk factor predisposing for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation 20-fold. TB is also the most common cause of AIDS-related death. Thus, M. tuberculosis and HIV act in synergy, accelerating the decline of immunological functions and leading to subsequent death if untreated. The mechanisms behind the breakdown of the immune defense of the co-infected individual are not well known. The aim of this review is to highlight immunological events that may accelerate the development of one of the two diseases in the presence of the co-infecting organism. We also review possible animal models for studies of the interaction of the two pathogens, and describe gaps in knowledge and needs for future studies to develop preventive measures against the two diseases.

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Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade.

Danielle Cazabon, Hannah Alsdurf, Srinath Satyanarayana … (2017)

Despite the high coverage of directly observed treatment short-course (DOTS), tuberculosis (TB) continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays), analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.

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Latent tuberculosis infection: An overview

S Koesters Kiazyk, TB Ball (2017)

Latent tuberculosis infection (LTBI) is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active tuberculosis (TB) disease. Individuals with LTBI represent a reservoir for active TB cases. The detection and management of LTBI is now a key component of the World Health Organization’s End TB Strategy and the Government of Canada’s federal framework for action on TB prevention and control. This is because people with LTBI can progress to active TB or undergo reactivation, a risk that is greatly increased in those with immunocompromising conditions. This overview provides a summary of LTBI and reactivation risk, as well as the recent advances in the diagnosis and treatment of LTBI.

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Author and article information

Journal

Journal ID (nlm-ta): J Korean Med Sci

Journal ID (iso-abbrev): J. Korean Med. Sci

Journal ID (publisher-id): JKMS

Title: Journal of Korean Medical Science

Publisher: The Korean Academy of Medical Sciences

ISSN (Print): 1011-8934

ISSN (Electronic): 1598-6357

Publication date (Electronic): 20 September 2019

Publication date Collection: 21 October 2019

Volume: 34

Issue: 40

Electronic Location Identifier: e259

Affiliations

[1 ]Department of Pulmonology and Respiratory Medicine, Faculty of Medicine/Moewardi Hospital, Universitas Sebelas Maret, Surakarta, Republic of Indonesia.

[2 ]Department of Microbiology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Republic of Indonesia.

[3 ]Department of Internal Medicine, Faculty of Medicine/Moewardi Hospital, Universitas Sebelas Maret, Surakarta, Republic of Indonesia.

Author notes

Address for Correspondence: Reviono Reviono, MD, Sp.P (K). Department of Pulmonology, Faculty of Medicine, Universitas Sebelas Maret, Jl Ir Sutami, No 36A, Kentingan, Surakarta, Central Java, Republic of Indonesia. reviono@ 123456staff.uns.ac.id

Author information

Reviono Reviono https://orcid.org/0000-0001-5463-1850

Leli Saptawati https://orcid.org/0000-0003-4689-0005

Dhani Redhono https://orcid.org/0000-0002-6639-1791

Betty Suryawati https://orcid.org/0000-0003-1493-3170

Article

DOI: 10.3346/jkms.2019.34.e259

PMC ID: 6801227

PubMed ID: 31625291

SO-VID: cb6d2e9d-8be1-4986-867b-e9bfd94a68e1

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 15 April 2019

Date accepted : 20 August 2019

Funding

Funded by: Universitas Sebelas Maret, CrossRef https://doi.org/10.13039/501100007690;

Good Agreement between an Interferon Gamma Release Assay and Tuberculin Skin Tests in Testing for Latent Tuberculosis Infection among HIV-Infected Patients in Indonesia

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Point-Of-Care Testing for Tuberculosis

Most cited references 25

Tuberculosis and HIV Co-Infection

Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade.

Latent tuberculosis infection: An overview

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