Chest
Original ResearchChest InfectionsPredictive Value of Interferon-γ Release Assays and Tuberculin Skin Testing for Progression From Latent TB Infection to Disease State
Section snippets
Search Methods for Identification of Studies
Original articles, letters to the editor, and published abstracts were identified by computerized searches of MEDLINE (up to October 10, 2011), EMBASE (up to October 10, 2011), and the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library 2009, issue 3), combining the search terms used in a previous meta-analysis.5 No restrictions were made with respect to language or basic study design (prospective or retrospective), determination of predictive values not being the main
Results
As shown in Figure 1, a total of 241 papers were obtained through database searching and, of these, 28 publications were finally eligible for inclusion in this review: 18 for the TST, 23 for commercial, and five for “in-house” IGRAs (Table 1). In two studies,13, 14 more than one IGRA had been performed. Accordingly, results of both tests were analyzed. Five studies used “in-house” tests,15, 16, 17, 18, 19 four QFT-G,13, 20, 21, 22 14 QFT-GIT,14, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35
Discussion
In our meta-analysis, we included 28 studies with totals of 1,225, 5,194, and 8,479 subjects tested by “in-house” IGRAs, commercial IGRAs, and the TST, respectively, to calculate a pooled value for PPV for progression, and totals of 2,009, 12,154, and 8,618 subjects, respectively, to calculate an NPV. The IGRAs showed a significantly higher PPV than did the TST, especially when using commercially available IGRAs. PPV for progression largely depends on specificity, and only truly infected
Conclusions
In conclusion, positive test results of both commercial and “in-house” IGRAs have a higher PPV for progression to active TB than do those of the TST. Pooled NPVs for progression to exclude LTBI are very high for both IGRAs and TST, although the commercial IGRAs show a small, but statistically significant, superiority. Progression rates for commercial IGRAs are remarkably higher than those for the TST, but remain low in absolute numbers. Data suggest that IGRAs provide significant benefits over
Acknowledgments
Author contributions:Dr Diel: contributed to the article concept, statistical analysis, and drafting of the manuscript.
Dr Loddenkemper: contributed to the article concept, design of the study, and drafting of the manuscript.
Dr Nienhaus: contributed to the article concept, design of the study, acquisition and selection of data, and drafting of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Diel has received travel
References (41)
- et al.
Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis
Chest
(2010) - et al.
Predictive value of interferon-gamma release assays for incident active tuberculosis: a systematic review and meta-analysis
Lancet Infect Dis
(2012) - et al.
Contact investigation in a primary school using a whole blood interferon-gamma assay
J Infect
(2009) - et al.
Use of an interferon-gamma based assay to assess bladder cancer patients treated with intravesical BCG and exposed to tuberculosis
Clin Biochem
(2007) - et al.
Detection of latent tuberculosis by the tuberculin skin test and a whole-blood interferon-γ release assay, and the development of active tuberculosis in HIV-seropositive persons
Diagn Microbiol Infect Dis
(2011) - et al.
Performance of confirmatory interferon-gamma release assay in school tuberculosis outbreaks
Chest
(2012) - et al.
A prospective longitudinal study evaluating the usefulness of a T-cell-based assay for latent tuberculosis infection in kidney transplant recipients
Am J Transplant
(2011) 2011/2012 Tuberculosis Global Facts
(2011)- et al.
The prognosis of a positive tuberculin reaction in childhood and adolescence
Am J Epidemiol
(1974) - et al.
Eliminating human tuberculosis in the twenty-first century
J R Soc Interface
(2008)
Epidemiological benefits of more-effective tuberculosis vaccines, drugs, and diagnostics
Proc Natl Acad Sci U S A
Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis
Eur Respir J
Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis
Eur Respir J
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
PLoS Med
The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews
BMC Med Res Methodol
Isoniazid for preventing tuberculosis in non-HIV infected persons
Cochrane Database Syst Rev
Targeted tuberculin testing and treatment of latent tuberculosis infection
MMWR Recomm Rep
High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis: comparison of QuantiFERON-TB GOLD, ELISPOT, and tuberculin skin test
Infection
Predictive value for progression to tuberculosis by IGRA and TST in immigrant contacts
Eur Respir J
Immune responses to the Mycobacterium tuberculosis-specific antigen ESAT-6 signal subclinical infection among contacts of tuberculosis patients
J Clin Microbiol
Cited by (0)
Funding/Support: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.