Evaluating latent tuberculosis infection diagnostics using latent class analysis. Issue 11 (7th July 2018)

• Record Type: Journal Article
• Authors: Stout, Jason E; Wu, Yanjue; Ho, Christine S; Pettit, April C; Feng, Pei-Jean; Katz, Dolly J; Ghosh, Smita; Venkatappa, Thara; Luo, Ruiyan
• Other Names: author non-byline.; Flood Jennifer author non-byline.; Pascopella Lisa author non-byline.; Higashi Julie author non-byline.; Moore Marisa author non-byline.; Garfein Richard author non-byline.; Benson Constance author non-byline.; Belknap Robert author non-byline.; Reves Randall author non-byline.; Ahmed Amina author non-byline.; Sterling Timothy author non-byline.; Pettit April author non-byline.; Blumberg Henry M author non-byline.; Oladele Alawode author non-byline.; Lauzardo Michael author non-byline.; Séraphin Marie Nancy author non-byline.; Brostrom Richard author non-byline.; Khurana Renuka author non-byline.; Cronin Wendy author non-byline.; Dorman Susan author non-byline.; Narita Masahiro author non-byline.; Horne David author non-byline.; Miller Thaddeus author non-byline.
• Is Part Of: Thorax. Volume 73:Issue 11(2018)
• Page Start: 1062
• Page End: 1070
• Publication Date: 2018-07-07
• Subjects: tuberculosis -- clinical epidemiology; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2018-211715
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : 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 .