QuantiFERON-TB Gold In-Tube as a Confirmatory Test for Tuberculin Skin Test in Tuberculosis Contact Tracing: A Noninferiority Clinical Trial

Muñoz, Laura; Santín, Miguel; Alcaide, Fernando; Ruiz‐Serrano, María Jesús; Gijón, Paloma; Bermúdez, Elena; Domínguez-Castellano, Ángel; Navarro, María Dolores; Ramírez, Encarnación; Pérez-Escolano, Elvira; López-Prieto, María Dolores; Gutiérrez-Rodriguez, José; Anibarro, Luis; Calviño, Laura; Trigo, Matilde; Cifuentes, Carmen; García-Gasalla, Mercedes; Payeras, Antoni; Gasch, Oriol; Espasa, Mateu; Agüero, Ramón; Ferrer, Diego; Casas, Xavier; González-Cuevas, Araceli; Garcia-Zamalloa, Alberto; Bikuña, Edurne; Lecuona, Marı́a; Galindo, Rosa; Ramírez-Lapausa, Marta; Carrillo, Raquel; Team, Optimist Study

doi:10.1093/cid/cix745

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…The use of IGRA as a confirmatory test following TST is not endorsed by Canadian or World Health Organization guidelines [13, 24]. However, this strategy is recommended for some low risk patients in American guidelines [25] and a recent trial found it to be non-inferior to TST alone [26], suggesting that it may be reasonable in some cases.…”

Section: Discussionmentioning

confidence: 99%

The latent tuberculosis infection cascade of care in Iqaluit, Nunavut, 2012–2016

Pease

Zwerling²,

Mallick

et al. 2019

BMC Infect Dis

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BackgroundA remote arctic region of Canada predominantly populated by Inuit with the country’s highest incidence of tuberculosis.MethodsThe study was undertaken to describe the latent tuberculosis infection (LTBI) cascade of care and identify factors associated with non-initiation and non-completion of LTBI treatment. Data were extracted retrospectively from medical records for all patients with a tuberculin skin test (TST) implanted in Iqaluit, Nunavut between January 2012 and March 2016. Associations between demographic and clinical factors and both treatment non-initiation among and treatment non-completion were identified using log binomial regression models where convergence could be obtained and Poisson models with robust error variance where convergence was not obtained.ResultsOf 2303 patients tested, 439 (19.1%) were diagnosed with LTBI. Treatment was offered to 328 patients, was initiated by 246 (75.0% of those offered) and was completed by 186 (75.6% of initiators). In multivariable analysis, older age (adjust risk ratio [aRR] 1.17 per 5-year increase, 95%CI:1.09–1.26) and undergoing TST due to employment screening (aRR 1.63, 95%CI:1.00–2.65, compared to following tuberculosis exposure) were associated with increased non-initiation of treatment. Older age (aRR 1.13, 95%CI: 1.03–1.17, per 5-year increase) was associated with increased non-completion of treatment.ConclusionsA similar rate of treatment initiation and higher rate of treatment completion were found compared to previous North American studies. Interventions targeting older individuals and those identified via employment screening may be considered to help to address the largest losses in the cascade of care.

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Section: Discussionmentioning

confidence: 99%

The latent tuberculosis infection cascade of care in Iqaluit, Nunavut, 2012–2016

Pease

Zwerling²,

Mallick

et al. 2019

BMC Infect Dis

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“…The sample size was determined based on the assumption that around 35% of contacts would have a positive initial result [ 15 ]. Assuming a prevalence of 35% negative results for the first repeated test (QFT-1) [ 1 , 4 ], with 80% of these remaining negative in QFT-2, 355 contacts were needed to obtain a sample of 113 with a positive initial result (QFT-i).…”

Section: Methodsmentioning

confidence: 99%

Reversions of QuantiFERON-TB Gold Plus in tuberculosis contact investigation: A prospective multicentre cohort study

Pérez-Recio,

Grijota-Camino,

Anibarro

et al. 2023

PLoS ONE

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Background Interferon-y Release Assays (IGRA) reversions have been reported in different clinical scenarios for the diagnosis of tuberculosis (TB) infection. This study aimed to determine the rate of QuantiFERON-TB Gold Plus (QFT-Plus) reversions during contact investigation as a potential strategy to reduce the number of preventive treatments. Methods Prospective, multicentre cohort study of immunocompetent adult contacts of patients with pulmonary TB tested with QFT-Plus. Contacts with an initial positive QFT-Plus (QFT-i) underwent a second test within 4 weeks (QFT-1), and if negative, underwent a repeat test 4 weeks later (QFT-2). Based on the QFT-2 result, we classified cases as sustained reversion if they remained negative and as temporary reversion if they turned positive. Results We included 415 contacts, of whom 96 (23.1%) had an initial positive test (QFT-i). Following this, 10 had negative QFT-1 results and 4 (4.2%) of these persisted with a negative result in the QFT-2 (sustained reversions). All four sustained reversions occurred in contacts with IFN-γ concentrations between ≥0.35 and ≤0.99 IU•mL-1 in one or both QFT-i tubes. Conclusion In this study, TB contact investigations rarely reveal QFT-Plus reversion. These results do not support retesting cases with an initial positive result to reduce the number of preventive treatments.

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“…It is reasonable to confirm a positive TST result with an IGRA in low TB incidence settings, to rule out nontuberculous mycobacterial infection. 21 For those who test negative with ongoing risk factors for active TB, annual screening is warranted. Testing should not be repeated among those with a previously positive test.…”

Section: Diagnosis Of Latent Tuberculosismentioning

confidence: 99%

Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out

Letang

Ellis

Naidoo

et al. 2020

Archivos de Bronconeumología

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Despite wide antiretroviral scale-up during the past two decades resulting in declining new infections and mortality globally, HIV-associated tuberculosis remains as a major public health concern. Tuberculosis is the leading HIV-associated opportunistic infection and the main cause of death globally and, particularly, in resource-limited settings. Several challenges exist regarding diagnosis, global implementation of latent tuberculosis treatment, management of active tuberculosis, delivery of optimal patient-centered TB and HIV prevention and care in high burden countries. In this article we review the advances on pathogenesis, diagnosis, and treatment after nearly two decades of global roll-out of antiretroviral therapy and discuss the current challenges for the global control of tuberculosis-HIV co-infection.

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QuantiFERON-TB Gold In-Tube as a Confirmatory Test for Tuberculin Skin Test in Tuberculosis Contact Tracing: A Noninferiority Clinical Trial

Abstract: NCT01223534.

Cited by 15 publications

References 18 publications

The latent tuberculosis infection cascade of care in Iqaluit, Nunavut, 2012–2016

The latent tuberculosis infection cascade of care in Iqaluit, Nunavut, 2012–2016

Reversions of QuantiFERON-TB Gold Plus in tuberculosis contact investigation: A prospective multicentre cohort study

Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out

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