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Evaluation of the feasibility of utilizing the Quantiferon-TB Gold test at an HIV comprehensive care clinic in La Romana, Dominican Republic
Investigator: Jorien Breur
Mentors: Philip LaRussa, MD and Magdalena Sobieszczyk, MD
Background: In resource-constrained settings, tuberculosis (TB) is the leading cause of death among people living with HIV; HIV co-infection is the strongest risk factor for progression of recent or latent tuberculosis infection (LTBI) to active disease. There is an urgent need for an accurate, rapid, cost-effective, and easy to implement TB diagnostic test. We evaluated the programmatic feasibility of incorporating the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay into a clinical algorithm for the detection of latent/active TB among HIV-infected patients in La Romana, Dominican Republic.
Methods: Newly diagnosed HIV-infected patients initiating care at Clínica de Familia La Romana were screened for TB using QFT-GIT assay. Patients were followed for 6 months.
Results: Ninety-two newly diagnosed HIV-infected patients were screened with QFT-GIT assay. Mean age was 40.4 years, 57.6% were male, 65.2% and 21.5% were Dominican and Haitian, respectively, and majority were urban dwelling (78.3). 68 (73.9%) QFT-GIT tests were negative and 10 (10.7%) positive. Fourteen (15.2%) were never reported by the laboratory. In 8 out of 10 patients with positive QFT-GIT, active TB disease was ruled out with negative chest radiograph and AFB sputum smears; their mean CD4 count was 385 cells/μL. Among those with negative QFT-GIT, seven cases of TB co-infection were identified based on the current standard TB criteria; their mean CD4 count was 308 cells/μL.
Conclusion: In this context, there was a high rate of lost results (15.2%) and poor agreement among the tests with at least one positive and one negative diagnostic test for TB (19.6%). This unreliability and lack of agreement in the absence of a gold standard TB diagnostic tool, makes it challenging to determine the utility of including QFT-GIT in a clinical diagnostic algorithm. Improved modalities are needed for the diagnosis of LTBI and active TB in HIV-infected individuals.
Last updated: 10/2/2014
Updated on September 2, 2014.