Interferon-gamma release assay versus tuberculin skin test for latent tuberculosis infection among HIV patients in Brazil

SettingPatients HIV+ attending in a reference clinic, Southern Brazil.ObjectiveTo compare the interferon-gamma-release assay (IGRA – QuantiFERON® TB Gold In-Tube) with the tuberculin skin test (TST – PPD-Rt 23) for latent tuberculosis infection (LTBI) in patients with HIV.DesignCohort study. Patients were simultaneously submitted to the TST and blood collection for the IGRA.ResultsA total of 140 subjects were included. Nine (6.4%) were IGRA+/TST+, 12 (8.6%) were IGRA+/TST−, 4 (3%) were IGRA−/TST+, and 115 (82%) IGRA−/TST−. There was poor agreement between tests (kappa = 0.2), and no correlation between these results and CD4+ T lymphocyte counts. During follow-up, one patient with negative results on both tests died from sepsis, and another with discordant results (IGRA+/TST−) exhibited TST seroconversion. Compared to the TST, IGRA showed a sensitivity and specificity of 69% and 90%, respectively. The IGRA detected 8% more positive results than the TST. All patients were followed up for 2 years.ConclusionThe higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.