%0 Journal Article
%T Improved sensitivity of an interferon-gamma release assay (T-SPOT.TB£¿) in combination with tuberculin skin test for the diagnosis of latent tuberculosis in the presence of HIV co-Infection
%A Luigia Elzi
%A Ingrid Steffen
%A Hansjakob Furrer
%A Jan Fehr
%A Matthias Cavassini
%A Bernard Hirschel
%A Matthias Hoffmann
%A Enos Bernasconi
%A Stefano Bassetti
%A Manuel Battegay
%J BMC Infectious Diseases
%D 2011
%I BioMed Central
%R 10.1186/1471-2334-11-319
%X IGRA (T-SPOT.TB) was performed using lymphocytes stored within 6 months before culture-confirmed tuberculosis was diagnosed in HIV-infected individuals in the Swiss HIV Cohort Study.64 individuals (69% males, 45% of non-white ethnicity, median age 35 years (interquartile range [IQR] 31-42), 28% with prior AIDS) were analysed. Median CD4 cell count was 223 cells/¦Ìl (IQR 103-339), HIV-RNA was 4.7 log10 copies/mL (IQR 4.3-5.2). T-SPOT.TB resulted positive in 25 patients (39%), negative in 18 (28%) and indeterminate in 21 (33%), corresponding to a sensitivity of 39% (95% CI 27-51%) if all test results were considered, and 58% (95% CI 43-74%) if indeterminate results were excluded. Sensitivity of IGRA was independent of CD4 cell count (p = 0.698). Among 44 individuals with available TST, 22 (50%) had a positive TST. Agreement between TST and IGRA was 57% (kappa = 0.14, p = 0.177), and in 34% (10/29) both tests were positive. Combining TST and IGRA (at least one test positive) resulted in an improved sensitivity of 67% (95% CI 52-81%). In multivariate analysis, older age was associated with negative results of TST and T-SPOT.TB (OR 3.07, 95% CI 1,22-7.74, p = 0.017, per 10 years older).T-SPOT.TB and TST have similar sensitivity to detect latent TB in HIV-infected individuals. Combining TST and IGRA may help clinicians to better select HIV-infected individuals with latent tuberculosis who qualify for preventive treatment.Tuberculosis (TB) continues to be a global public health epidemic with 2 million deaths yearly [1]. One third of the world's population is latently infected with Mycobacterium tuberculosis [2]. HIV-infected individuals are particularly susceptible to TB, both from new infection with rapid progression to active disease and reactivation of latent infection occurring in 20-30% of subjects with a positive tuberculin skin test (TST) [3-5].There is still no reliable test to detect latent TB. The TST with purified protein derivative (PPD) by the Mantoux method ha
%U http://www.biomedcentral.com/1471-2334/11/319