Adults with Mycobacterium tuberculosis infection and pre-diabetes have increased levels of QuantiFERON interferon-gamma responses. (May 2020)

• Record Type: Journal Article
• Authors: Magee, Matthew J.; Trost, Susanna L.; Salindri, Argita D.; Amere, Genet; Day, Cheryl L.; Gandhi, Neel R.
• Is Part Of: Tuberculosis. Volume 122(2020)
• Publication Date: 2020-05
• Subjects: Tuberculosis infection -- Diabetes mellitus -- Interferon-gamma; 616.995
• DOI: 10.1016/j.tube.2020.101935
• Languages: English
• ISSNs: 1472-9792

Abstract

Abstract: Background: Diabetes is associated with increased prevalence of TB infection in the US. We assessed associations between diabetes and interferon-gamma (IFN-γ) TB antigen response among adults with TB infection using US representative data. Methods: National Health and Nutrition Examination (NHANES) participants >19 years from 2011 to 2012 with positive QuantiFERON®-TB Gold-In-Tube (QFT) results were eligible. Diabetes was defined by combination of self-report and glycated hemoglobin (HbA1c). Quantitative IFN-γ TB antigen was classified as high ( ≥ 10 IU/mL), intermediate (1.01–9.99 IU/mL), or low (0.35–1.00 IU/mL). Analyses accounted for NHANES weighted design. Results: Among NHANES participants >19 years, n = 513 had positive QFT (5.9%). Among those with positive QFT, diabetes prevalence was 22.2% and pre-diabetes was 25.9%. Overall, 16.7% of positive QFT participants had high IFN-γ TB antigen levels including 21.7% among those with diabetes, 20.8% among those with pre-diabetes, and 12.6% among euglycemic participants. In adjusted analyses, high IFN-γ TB antigen response was more common among those with pre-diabetes (aOR 1.9, 95%CI 1.0, 3.6) compared to euglycemic participants. Conclusion: Higher antigen responses may reflect immunopathy consistent with an exaggerated inflammatory but ineffectual response to TB or a reflection of more Mtb replication in participants with pre-diabetes or diabetes. Highlights: Latent tuberculosis infection prevalence is higher in patients with pre-diabetes. Adults with LTBI and diabetes had higher quantitative QFT TB antigen responses. LTBI-diabetes link unlikely due to hyperglycemia inhibited IFN-γ TB antigen responses.