Evaluating latent tuberculosis infection diagnostics using latent class analysis

Details

• Alternative Title:
  Thorax
• Personal Author:
  Stout, Jason E ; Wu, Yanjue ; Ho, Christine S ; Pettit, April C ; Feng, Pei-Jean ; Katz, Dolly J ; Ghosh, Smita ; Venkatappa, Thara ; Luo, Ruiyan
• Description:
  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.
  
  
• Subjects:
  Adolescent Adult Article Bayes Theorem Child Child, Preschool Female Follow-Up Studies Humans Incidence Latent Class Analysis Latent Tuberculosis Male Mass Screening Middle Aged Mycobacterium Tuberculosis Prospective Studies Reproducibility Of Results Tuberculin Test United States Young Adult

  More +
• Source:
  Thorax. 73(11):1062-1070
• Pubmed ID:
  29982223
• Pubmed Central ID:
  PMC6494673
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  73
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:5a9f9f2f28bc630bb4e05145c09f373833c171d1de2ace00019daa4f08389bd9
• Download URL:
  https://stacks.cdc.gov/view/cdc/78317/cdc_78317_DS1.pdf
• File Type:
  [PDF - 690.69 KB ]