Evaluating latent tuberculosis infection diagnostics using latent class analysis.

Published

Journal Article

BACKGROUND: Lack of a gold standard for latent TB infection has precluded direct measurement of test characteristics of the tuberculin skin test and interferon-γ release assays (QuantiFERON Gold In-Tube and T-SPOT.TB). OBJECTIVE: We estimated test sensitivity/specificity and latent TB infection prevalence in a prospective, US-based cohort of 10 740 participants at high risk for latent infection. METHODS: Bayesian latent class analysis was used to estimate test sensitivity/specificity and latent TB infection prevalence among subgroups based on age, foreign birth outside the USA and HIV infection. RESULTS: Latent TB infection prevalence varied from 4.0% among foreign-born, HIV-seronegative persons aged <5 years to 34.0% among foreign-born, HIV-seronegative persons aged ≥5 years. Test sensitivity ranged from 45.8% for the T-SPOT.TB among foreign-born, HIV-seropositive persons aged ≥5 years to 80.7% for the tuberculin skin test among foreign-born, HIV-seronegative persons aged ≥5 years. The skin test was less specific than either interferon-γ release assay, particularly among foreign-born populations (eg, the skin test had 70.0% specificity among foreign-born, HIV-seronegative persons aged ≥5 years vs 98.5% and 99.3% specificity for the QuantiFERON and T-SPOT.TB, respectively). The tuberculin skin test's positive predictive value ranged from 10.0% among foreign-born children aged <5 years to 69.2% among foreign-born, HIV-seropositive persons aged ≥5 years; the positive predictive values of the QuantiFERON (41.4%) and T-SPOT.TB (77.5%) were also low among US-born, HIV-seropositive persons aged ≥5 years. CONCLUSIONS: These data reinforce guidelines preferring interferon-γ release assays for foreign-born populations and recommending against screening populations at low risk for latent TB infection. TRIAL REGISTRATION NUMBER: NCT01622140.

Full Text

Duke Authors

Cited Authors

  • Stout, JE; Wu, Y; Ho, CS; Pettit, AC; Feng, P-J; Katz, DJ; Ghosh, S; Venkatappa, T; Luo, R; Tuberculosis Epidemiologic Studies Consortium,

Published Date

  • November 2018

Published In

Volume / Issue

  • 73 / 11

Start / End Page

  • 1062 - 1070

PubMed ID

  • 29982223

Pubmed Central ID

  • 29982223

Electronic International Standard Serial Number (EISSN)

  • 1468-3296

Digital Object Identifier (DOI)

  • 10.1136/thoraxjnl-2018-211715

Language

  • eng

Conference Location

  • England