Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States

Details

• Alternative Title:
  Ann Am Thorac Soc
• Personal Author:
  Zavala, Sofia ; Winglee, Kathryn ; Ho, Christine S. ; Pettit, April C. ; Ahmed, Amina ; Katz, Dolly J. ; Belknap, Robert W. ; Stout, Jason E.
• Description:
  Rationale:
  
  Detection of latent tuberculosis infection (LTBI) in persons born in high tuberculosis (TB) incidence countries living in low TB incidence countries is key to TB elimination in low-incidence countries. Optimizing LTBI tests is critical to targeting treatment.
  
  Objectives:
  
  To compare the sensitivity and specificity of tuberculin skin test (TST) and two interferon-γ release assays at different cutoffs and of a single test versus dual testing.
  
  Methods:
  
  We examined a subset (N = 14,167) of a prospective cohort of people in the United States tested for LTBI. We included non–U.S.-born, human immunodeficiency virus-seronegative people ages 5 years and older with valid TST, QuantiFERON-TB Gold-in-Tube (QFT), and T-SPOT.TB (TSPOT) results. The sensitivity/specificity of different test cutoffs and test combinations, obtained from a Bayesian latent class model, were used to construct receiver operating characteristic (ROC) curves and assess the area under the curve (AUC) for each test. The sensitivity/specificity of dual testing was calculated.
  
  Results:
  
  The AUC of the TST ROC curve was 0.81 (95% credible interval (CrI), 0.78–0.86), with sensitivity/specificity at cutoffs of 5, 10, and 15 mm of 86.5%/61.6%, 81.7%/71.3%, and 55.6%/88.0%, respectively. The AUC of the QFT ROC curve was 0.89 (95% CrI, 0.86–0.93), with sensitivity/specificity at cutoffs of 0.35, 0.7, and 1.0 IU/mL of 77.7%/98.3%, 66.9%/99.1%, and 61.5%/99.4%. The AUC of the TSPOT ROC curve was 0.92 (95% CrI, 0.88–0.96) with sensitivity/specificity for five, six, seven, and eight spots of 79.2%/96.7%, 76.8%/97.7%, 74.0%/98.6%, and 71.8%/99.5%. Sensitivity/specificity of TST-QFT, TST-TSPOT, and QFT-TSPOT at standard cutoffs were 73.1%/99.4%, 64.8%/99.8%, and 65.3%/100%.
  
  Conclusion:
  
  Interferon-γ release assays have a better predictive ability than TST in people at high risk of LTBI.
  
  
• Subjects:
  Bayes Theorem Humans Interferon-gamma Release Tests Latent Tuberculosis Prospective Studies Tuberculin Test Tuberculosis
• Keywords:
  Interferon γ Release Assay Latent Class Analysis Latent Tuberculosis Test Cutoffs Tuberculin Skin Test
• Source:
  Ann Am Thorac Soc. 20(9):1258-1266
• Pubmed ID:
  37159954
• Pubmed Central ID:
  PMC10938364
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  20
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:047f1fd0d7e0407cb49ab56102d781f37a38d36a851c93621085e338fca531e10e20a5e9a0462122793dab6dd1fd2ed87efaf9496d95b55b527c2f3000754920
• Download URL:
  https://stacks.cdc.gov/view/cdc/151713/cdc_151713_DS1.pdf
• File Type:
  [PDF - 1.19 MB ]