Position statement on interferon-γ release assays in the detection of latent tuberculosis infection
DOI:
https://doi.org/10.33321/cdi.2012.36.8Keywords:
latent tuberculosis infection, detectionAbstract
In vitro T-cell based interferon-y (IFN-y) release assays (IGRAs), the QuantiFERON-TB Gold In-Tube test (QFN-GIT) (Cellestis Limited, Carnegie, Victoria, Australia) and the T-SPOT.TB test (T-Spot) (Oxford Immunotec Limited, Abingdon, United Kingdom), are marketed as a substitute for the tuberculin skin test (TST). The specificity of these immunoassays has been optimised by using Mycobacterium tuberculosis-specific antigens. IGRAs are more specific in patients with previous Bacille Calmette-Guérin (BCG) immunisation or exposure to non-tuberculous mycobacteria (NTM).
There have been a plethora of comparative studies of TST and IGRAs, several meta-analyses in specific patient groups, and a few longitudinal studies of the predictive ability of IGRA-positive results for the development of active tuberculosis (TB) disease. A summary of these studies is that IGRAs have not been clearly demonstrated to be superior to TST. The National Tuberculosis Advisory Committee (NTAC) also notes a continuing absence of cost-effectiveness studies of IGRAs under Australasian TB program conditions. Furthermore, TST remains a familiar test with a long history of use and longitudinal data that provides important predictive information that is not yet available with IGRA.
TST therefore remains the preferred test for latent tuberculosis infection (LTBI) in most patient groups. IGRAs may be used as supplemental tests to improve specificity in screening immunocompetent subjects and in addition to TST in immunocompromised patients considered at high risk of LTBI. The specific recommendations in various patient groups are listed in the body of the text.
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