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. 2008 Jan 16;3(1):e1441.
doi: 10.1371/journal.pone.0001441.

Sensitivity of IFN-gamma release assay to detect latent tuberculosis infection is retained in HIV-infected patients but dependent on HIV/AIDS progression

Farba Karam  1 , Fatou Mbow, Helen Fletcher, Cheikh S Senghor, Koura D Coulibaly, Andrea M LeFevre, Ndeye F Ngom Gueye, Tandakha Dieye, Papa S Sow, Souleymane Mboup, Christian Lienhardt
Affiliations

Sensitivity of IFN-gamma release assay to detect latent tuberculosis infection is retained in HIV-infected patients but dependent on HIV/AIDS progression

Farba Karam et al. PLoS One. .

Abstract

Background: Detection and treatment of latent TB infection (LTBI) in HIV infected individuals is strongly recommended to decrease morbidity and mortality in countries with high levels of HIV.

Objective: To assess the validity of a newly developed in-house ELISPOT interferon-gamma release assay (IGRA) for the detection of LTBI amongst HIV infected individuals, in comparison with the Tuberculin Skin Test (TST).

Methodology/principal findings: ESAT6/CFP10 (EC) ELISPOT assays were performed, together with a TST, in 285 HIV infected individuals recruited in HIV clinics in Dakar, Senegal, who had no signs of active TB at time of enrolment. Thirty eight of the subjects (13.3%) failed to respond to PHA stimulation and were excluded from the analysis. In the 247 remaining patients, response to PHA did not vary according to CD4 cell count categories (p = 0.51). EC ELISPOT was positive in 125 (50.6%) subjects, while 53 (21.5%) had a positive TST. Concordance between EC ELISPOT and TST was observed in 151 patients (61.1%) (kappa = 0.23). The proportion of subjects with a positive response to the EC ELISPOT assay decreased with declining CD4 counts (p trend = 0.001), but were consistently higher than the proportion of TST responders. In multivariate analysis, the risk of being EC-ELISPOT positive in HIV infected individuals was associated with age, CD4 count and HIV-1 strain.

Conclusion: Our study indicates that IGRAs using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals, but may be impaired by T-cell anergy in severely immuno-suppressed individuals.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Distribution of responses to PHA and ESAT6/CFP10 ELISPOT assays in HIV patients, by CD4 cell count (boxplot showing median, IQR and range) (n = 285).
1A: Distribution of responses to PHA. 1B: Distribution of responses to ESAT6/CFP10.
Figure 2
Figure 2. Percentage of positive responders to ESAT6/CFP10 ELISPOT and to TST, by CD4 cell count (n = 247).
See this image and copyright information in PMC

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