Effect of HIV-infection on QuantiFERON-plus accuracy in patients with active tuberculosis and latent infection

• Published in: The Journal of infection Vol. 80; no. 5; pp. 536 - 546
• Main Authors: Petruccioli, Elisa, Chiacchio, Teresa, Navarra, Assunta, Vanini, Valentina, Cuzzi, Gilda, Cimaglia, Claudia, Codecasa, Luigi Ruffo, Pinnetti, Carmela, Riccardi, Niccolò, Palmieri, Fabrizio, Antinori, Andrea, Goletti, Delia
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2020
• Subjects: HIV; HIV Infections - complications; Humans; IGRA; Interferon-gamma Release Tests; Latent Infection; Latent tuberculosis; Latent Tuberculosis - complications; Latent Tuberculosis - diagnosis; M.tuberculosis; Mycobacterium tuberculosis; QuantiFERON-TB Gold Plus; Tuberculin Test; Tuberculosis - complications; Tuberculosis - diagnosis; Latent tuberculosis; HIV; M.tuberculosis; QuantiFERON-TB Gold Plus; IGRA
• ISSN: 0163-4453; 1532-2742; 1532-2742
• DOI: 10.1016/j.jinf.2020.02.009

•QFT-Plus has similar sensitivity for active TB detection independently of HIV infection.•CD4 count does not influence IFNγ values of QFT-Plus in HIV-TB patients.•HIV-LTBI have high proportion of IFNγ values in the “uncertain range” of QFT-Plus.•Impairment of CD4 response to QFT-Plus antigens in the HIV-infected subjects.•Similar CD8 response to QFT-Plus antigens in HIV-infected and –uninfected subjects. HIV-infection increases the risk to progress to active-tuberculosis (TB). Detection of latent TB infection (LTBI) is needed to eventually propose preventive-therapy and reduce TB reservoir. QuantiFERON-TB Plus (QFT-Plus)-test identifies LTBI. Currently, only two studies on QFT-Plus accuracy in HIV-infected-population are available in high TB-endemic-countries. Therefore we aimed to evaluate the effect of HIV-infection on QFT-Plus accuracy to detect LTBI in a low TB-endemic-country. We enrolled 465 participants, among the 167 HIV-infected-persons: 32 with active-TB (HIV-TB), 45 remote-LTBI (HIV-LTBI) and 90 at low M. tuberculosis (Mtb)-infection risk. Among the 298 HIV-uninfected-persons: 170 with active-TB, 76 recent-LTBI, 34 remote-LTBI and 18 with low Mtb-infection risk. QFT-Plus sensitivity was similar in TB regardless of HIV-status. CD4-count did not influence the distribution of IFN-γ values in HIV-TB and HIV-LTBI. Moreover HIV-LTBI and HIV-uninfected remote LTBI had a similar proportion of results in the uncertain range (IFNγ ≥0.2 ≤ 0.7 IU/ml) differently from those LTBI-persons reporting recent-exposure (p = 0.016). Cytometry results demonstrated that CD8-response was similar in HIV-infected- and -uninfected-persons whereas CD4-response was impaired in HIV-infected-persons (p = 0.011). HIV-infection does not affect QFT-Plus response in active-TB, whereas the time of exposure influences the proportion of uncertain-results in LTBI.