Interferon-Gamma Release Assays for the Diagnosis of Latent Tuberculosis Infection in HIV-Infected Individuals: A Systematic Review and Meta-Analysis

作者：Adithya Cattamanchi, Rachel M. Smith, Karen R Steingart, John Z. Metcalfe, Anand A. Date, Courtney Coleman, Barbara J. Marston, Laurence Huang, Philip C. Hopewell, Madhukar Pai · 发表于：JAIDS Journal of Acquired Immune Deficiency Syndromes · 年份：2011 · DOI：10.1097/qai.0b013e31820b07ab · 被引用次数：300 · 研究领域：Tuberculosis Research and Epidemiology、Infectious Diseases and Tuberculosis、Diagnosis and treatment of tuberculosis

OBJECTIVE: To determine whether interferon-gamma release assays (IGRAs) improve the identification of HIV-infected individuals who could benefit from latent tuberculosis infection therapy. DESIGN: Systematic review and meta-analysis. METHODS: We searched multiple databases through May 2010 for studies evaluating the performance of the newest commercial IGRAs (QuantiFERON-TB Gold In-Tube [QFT-GIT] and T-SPOT.TB [TSPOT]) in HIV-infected individuals. We assessed the quality of all studies included in the review, summarized results in prespecified subgroups using forest plots, and where appropriate, calculated pooled estimates using random effects models. RESULTS: The search identified 37 studies that included 5736 HIV-infected individuals. In three longitudinal studies, the risk of active tuberculosis was higher in HIV-infected individuals with positive versus negative IGRA results. However, the risk difference was not statistically significant in the two studies that reported IGRA results according to manufacturer-recommended criteria. In persons with active tuberculosis (a surrogate reference standard for latent tuberculosis infection), pooled sensitivity estimates were heterogeneous but higher for TSPOT (72%; 95% confidence interval [CI], 62-81%) than for QFT-GIT (61%; 95% CI, 47-75%) in low-/middle-income countries. However, neither IGRA was consistently more sensitive than the tuberculin skin test in head-to-head comparisons. Although TSPOT appeared to be less affected by i...