Gupta, RK;
Kunst, H;
Lipman, M;
Noursadeghi, M;
Jackson, C;
Southern, J;
Imran, A;
... Abubakar, I; + view all
(2020)
Evaluation of QuantiFERON-TB Gold Plus for Predicting Incident Tuberculosis among Recent Contacts: A Prospective Cohort Study.
Annals of the American Thoracic Society
, 17
(5)
pp. 646-650.
10.1513/AnnalsATS.201905-407RL.
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Abstract
Screening for latent tuberculosis infection (LTBI) among recent tuberculosis (TB) contacts is an important component of TB control, particularly in settings with low TB incidence aiming towards pre-elimination(1). However, currently available LTBI diagnostics lack sensitivity, and have poor predictive value for incident TB(2–8) Consequently, prevention of one incident TB case requires treatment of many for LTBI. This is true for both interferon gamma release assays (IGRAs) and the tuberculin skin test (TST); a recent evaluation found that QuantiFERON Gold-InTube (QFT-GIT; Qiagen, Hilden, Germany) and T-SPOT.TB (Oxford Immunotec, UK) perform similarly to the TST when a BCG-stratified TST cut-off is used(8). A newer generation QuantiFERON (QuantiFERON-TB Gold Plus; QFT-Plus) was recently launched, adding a second TB antigen tube (TB2) that incorporates short peptides designed to stimulate a CD8+ T-cell response, in addition to the CD4+ -response tube (TB1) included in previous versions. The proposed rationale for this is that CD8+ -responses have been associated with mycobacterial load and recent TB exposure(9, 10). Initial independent evaluations have suggested QFT-Plus may have improved test sensitivity in active TB compared to QFT-GIT(11), and that the CD8+ -targeted antigen tube response may be associated with proxy measures of degree of TB exposure among contacts(12). However, no studies have examined the prognostic value of QFT-Plus for predicting incident TB. We aimed to address this key knowledge gap in a prospective cohort of UK TB contacts.
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