Evaluating latent tuberculosis infection diagnostics using latent class analysis.
Journal Article (Journal Article;Multicenter Study)
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
- PMC6494673
Electronic International Standard Serial Number (EISSN)
- 1468-3296
Digital Object Identifier (DOI)
- 10.1136/thoraxjnl-2018-211715
Language
- eng
Conference Location
- England